Background and Aims Aortoesophageal fistula (AEF) is a relatively rare but often life-threatening condition. Although thoracic endovascular aortic repair (TEVAR) has been established as an alternative surgical strategy for thoracic aortic aneurysms and thoracic aortic dissections, the secondary AEF after TEVAR becomes more challenging. Here, the authors report the treatment modalities and outcomes of 7 cases with this disease.Methods The clinical data of 7 patients with secondary AEF complicated with graft infection after TEVAR treated between 2018 and 2021 were retrospectively analyzed. All patients underwent interventional or surgical treatment, including open surgery in 4 cases, that was off-pump extra-anatomical bypass from ascending aorta to abdominal aorta, excision of infected graft and infection lesion, and esophageal fistula drainage; TEVAR in 2 cases; staged TEVAR and open surgery in one case.Results Of the 5 patients who underwent primary and staged open surgery, 2 cases recovered and discharged, and 3 cases died. The 2 patients who underwent TEVAR alone and originally planned to perform open surgery after anti-infection and nutritional support treatment died during the treatment.Conclusion Conservative management or TEVAR alone often fails to save patients due to infected grafts and infection lesions. Although open surgery is associated with high mortality, complete removal of the infected lesions and grafts, extra-anatomical bypass from ascending aorta to abdominal aorta, and adequate drainage of the infected lesions are reasonable strategies for the treatment of graft infection complicated with aortoesophageal fistula after TEVAR under feasible conditions.