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Effective strategy in the treatment of aortobronchial fistula with recurrent hemoptysis

  • Son, Shin-Ah (Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital) ;
  • Lee, Deok Heon (Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital) ;
  • Kim, Gun-Jik (Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital)
  • Received : 2019.12.30
  • Accepted : 2020.02.06
  • Published : 2020.04.30

Abstract

Aortobronchial fistula (ABF) involves the formation of an abnormal connection between the thoracic aorta and the central airways or the pulmonary parenchyma and is associated with an increased risk of mortality. An ABF typically manifests clinically with symptoms of hemoptysis, and currently, there is a lack of defined guidelines for its treatment. Here, we report the cases of two patients who suffered from recurrent hemoptysis due to ABF with pseudoaneurysm. We propose that removal of the aorta with concomitant lung resection and coverage of the aorta using the pericardial membrane is a definite treatment to lower recurrence of ABF and persistent infection.

Keywords

References

  1. Czerny M, Reser D, Eggebrecht H, Janata K, Sodeck G, Etz C, et al. Aorto-bronchial and aorto-pulmonary fistulation after thoracic endovascular aortic repair: an analysis from the European Registry of Endovascular Aortic Repair Complications. Eur J Cardiothorac Surg 2015;48:252-7. https://doi.org/10.1093/ejcts/ezu443
  2. Chiesa R, Melissano G, Marone EM, Marrocco-Trischitta MM, Kahlberg A. Aorto-oesophageal and aortobronchial fistulae following thoracic endovascular aortic repair: a national survey. Eur J Vasc Endovasc Surg 2010;39:273-9. https://doi.org/10.1016/j.ejvs.2009.12.007
  3. Luehr M, Etz CD, Nozdrzykowski M, Garbade J, Lehmkuhl L, Schmidt A, et al. Emergency open surgery for aorto-oesophageal and aorto-bronchial fistulae after thoracic endovascular aortic repair: a single-centre experience. Eur J Cardiothorac Surg 2015;47:374-82. https://doi.org/10.1093/ejcts/ezu147
  4. Canaud L, D'Annoville T, Ozdemir BA, Marty-Ane C, Alric P. Combined endovascular and surgical approach for aortobronchial fistula. J Thorac Cardiovasc Surg 2014;148:2108-11. https://doi.org/10.1016/j.jtcvs.2014.01.018
  5. Canaud L, Ozdemir BA, Bahia S, Hinchliffe R, Loftus I, Thompson M. Thoracic endovascular aortic repair for aortobronchial fistula. Ann Thorac Surg 2013;96:1117-21. https://doi.org/10.1016/j.athoracsur.2013.04.090
  6. Czerny M, Eggebrecht H, Sodeck G, Weigang E, Livi U, Verzini F, et al. New insights regarding the incidence, presentation and treatment options of aorto-oesophageal fistulation after thoracic endovascular aortic repair: the European Registry of Endovascular Aortic Repair Complications. Eur J Cardiothorac Surg 2014;45:452-7. https://doi.org/10.1093/ejcts/ezt393
  7. Li M, Langlois N, Byard RW. Fatal aortobronchial fistula. J Forensic Leg Med 2013;20:395-8. https://doi.org/10.1016/j.jflm.2012.07.008
  8. Sica G, Rea G, Bocchini G, Lombardi R, Muto M, Valente T. Aortopulmonary fistula presenting without an endoleak after thoracic endovascular aortic repair. Korean J Thorac Cardiovasc Surg 2017;50:287-90. https://doi.org/10.5090/kjtcs.2017.50.4.287
  9. von Segesser LK, Tkebuchava T, Niederhauser U, Kunzli A, Lachat M, Genoni M, et al. Aortobronchial and aortoesophageal fistulae as risk factors in surgery of descending thoracic aortic aneurysms. Eur J Cardiothorac Surg 1997;12:195-201. https://doi.org/10.1016/S1010-7940(97)00142-5
  10. Girdauskas E, Falk V, Kuntze T, Borger MA, Schmidt A, Scheinert D, et al. Secondary surgical procedures after endovascular stent grafting of the thoracic aorta: successful approaches to a challenging clinical problem. J Thorac Cardiovasc Surg 2008;136:1289-94. https://doi.org/10.1016/j.jtcvs.2008.05.053
  11. Prokakis C, Koletsis E, Apostolakis E, Dedeilias P, Dougenis D. Aortoesophageal fistulas due to thoracic aorta aneurysm: surgical versus endovascular repair. Is there a role for combined aortic management? Med Sci Monit 2008;14:RA48-54.
  12. Bergqvist D, Bjorck M. Secondary arterioenteric fistulation: a systematic literature analysis. Eur J Vasc Endovasc Surg 2009;37:31-42. https://doi.org/10.1016/j.ejvs.2008.09.023
  13. Roselli EE, Abdel-Halim M, Johnston DR, Soltesz EG, Greenberg RK, Svensson LG, et al. Open aortic repair after prior thoracic endovascular aortic repair. Ann Thorac Surg 2014;97:750-6. https://doi.org/10.1016/j.athoracsur.2013.10.033
  14. Piciche M, De Paulis R, Fabbri A, Chiariello L. Postoperative aortic fistulas into the airways: etiology, pathogenesis, presentation, diagnosis, and management. Ann Thorac Surg 2003;75:1998-2006. https://doi.org/10.1016/S0003-4975(02)04837-3
  15. Eggebrecht H, Mehta RH, Dechene A, Tsagakis K, Kuhl H, Huptas S, et al. Aortoesophageal fistula after thoracic aortic stent-graft placement: a rare but catastrophic complication of a novel emerging technique. JACC Cardiovasc Interv 2009;2:570-6. https://doi.org/10.1016/j.jcin.2009.03.010