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cause of catastrophic gastrointestinal bleeding. Thoracic aortic aneurysms are the leading cause of AEF [1]. Early diagnosis and prompt endovascular and/or surgical intervention before massive exsanguinating hemorrhage are key to survival [2]. Temporary endoscopic management with esophageal stent placement has been reported as a bridge therapy [3,4]. We describe a case of AEF with active bleeding noted during an endoscopic examination that was treated with injection of N-butyl-2-cyanoacrylate (NBCA, Histoacryl), followed by successful placement of an endovascular aortic stent graft. A 69-year-old man with a history of ruptured diverticula that had been managed surgically presented to the emergency department with a 1-day history of chest pain and tarry stool, with hematemesis and hematochezia on the morning of admission. His heart rate was 95 beats/min and his blood pressure was 214/111mmHg. Laboratory data showed a rapid decline in hemoglobin (13.1 g/dL to 10.2 g/dL in 3 hours). Emergent esophagogastroduodenoscopy (EGD) revealed a 3-cm submucosal mass lesion with a spurting vessel 26 cm from the incisors (●" Fig. 1a). Two milliliters of NBCA mixed with lipiodol was injected locally, achieving temporary hemostasis. Contrast-enhanced computed tomography of the chest disclosed a descending thoracic aortic aneurysmwith a 5-mm AEF (●" Fig. 2). Aorta angiography revealed a 5-mm aneurysm without active extravasation in the mid thoracic aorta (●" Fig. 3a). The thoracic aortic aneurysm was repaired with a Cook Zenith II (34mm× 77mm) stent graft without complications (●" Fig. 3b). EGD after stent grafting the same day showed a submucosal mass measuring 3 cm × 1.8 cm with an erosive lesion and NBCA coating (●" Fig. 1b). Successful management of aortoesophageal fistula by combining endoscopic cyanoacrylate injection and endovascular stent grafting