Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Recurrent Aortobronchial Fistula after Endovascular Stenting for Infected Pseudoaneurysm of the Proximal Descending Thoracic Aorta: Case Report

  • Lee, Sun-Geun (Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine) ;
  • Lee, Seung Hyong (Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine) ;
  • Park, Won Kyoun (Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine) ;
  • Kim, Dae Hyun (Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine) ;
  • Song, Jae Won (Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine) ;
  • Cho, Sang-Ho (Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine)
  • Received : 2020.10.12
  • Accepted : 2020.11.12
  • Published : 2021.10.05
Download PDF
⟨ Previous Next ⟩

Abstract

Aortobronchial fistula (ABF) induced by an infected pseudoaneurysm of the thoracic aorta is a life-threatening condition. As surgical treatment is associated with significant mortality and morbidity, thoracic endovascular aneurysm repair (TEVAR) may be an alternative for the treatment of ABF. However, the long-term durability of this intervention is largely unknown and the recurrence of ABF is a potential complication. We experienced a case of recurrent ABF after stent grafting as an early procedure for an infected pseudoaneurysm of the thoracic aorta. Remnant ABF, bronchial and/or aortic wall erosion, vasa vasorum connected with ABF, and recurrent local inflammation of the thin aortic wall around ABF might cause recurrent hemoptysis. As a result, we suggest that TEVAR should be considered as a bridge therapy for the initial treatment of ABF resulting from an infected pseudoaneurysm, and that several options, such as second-stage surgery, should be considered to prevent the recurrence of ABF.

Keywords

References

  1. Riesenman PJ, Brooks JD, Farber MA. Thoracic endovascular aortic repair of aortobronchial fistulas. J Vasc Surg 2009;50:992-8. https://doi.org/10.1016/j.jvs.2009.03.001
  2. Kawaharada N, Kurimoto Y, Ito T, et al. Endovascular stent-graft repair of aortobronchial fistulas. Ann Thorac Surg 2012;94:524-9. https://doi.org/10.1016/j.athoracsur.2012.03.068
  3. Nishizawa J, Matsumoto M, Sugita T, et al. Surgical treatment of five patients with aortobronchial fistula in the aortic arch. Ann Thorac Surg 2004;77:1821-3. https://doi.org/10.1016/S0003-4975(03)00998-6
  4. 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
  5. Bailey CJ, Force S, Milner R, Kasirajan K, Veeraswamy RK. Thoracic endovascular repair as a safe management strategy for aortobronchial fistulas. J Vasc Surg 2011;53:1202-9. https://doi.org/10.1016/j.jvs.2010.10.103
  6. Bozzani A, Arici V, Odero A. Aortic stentgraft in aortobronchial fistula is a bridge solution? Ann Thorac Surg 2013;95:381-2. https://doi.org/10.1016/j.athoracsur.2012.04.117
  7. 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
  8. Nguyen T, Peters P, McGahan T, Shah P. Staged management of a primary aortobronchial fistula: a novel approach using a trapezius flap repair. Heart Lung Circ 2012;21:292-4. https://doi.org/10.1016/j.hlc.2012.01.002
  9. Touma Y, Demondion P, Rama A, Leprince P. Aortobronchial fistula in the presence of a midgraft hole after endovascular repair of thoracic aortic aneurysms. Eur J Cardiothorac Surg 2013;43:1259-61. https://doi.org/10.1093/ejcts/ezs653
  10. De Rango P, Estrera AL, Azizzadeh A, Keyhani K, Safi HJ. Two-stage safe repair of aortobronchial fistula. Ann Thorac Surg 2010;89:275-7. https://doi.org/10.1016/j.athoracsur.2009.06.035