Pseudoaneurysm and aortobronchial fistula after surgical bypass for aortic coarctation: management with endovascular stent-graft.
OBJECTIVE
To report the endovascular repair of an aortobronchial fistula at the distal anastomosis of a complex thoracic graft.


METHODS
A 61-year-old man operated 18 years prior for aortic coarctation presented with hemoptysis. An aortobronchial fistula was suspected, but spiral computed tomography and angiography showed only a small pseudoaneurysm at the distal anastomosis without revealing the fistulous tract. A Talent stent-graft was successfully deployed through a femoral access, but the large delivery system injured the external iliac artery, producing a retroperitoneal hemorrhage. Prompt balloon occlusion of the aorta and subsequent bypass graft repair of the arterial injury prevented serious sequelae. The patient recovered without further complications. Follow-up imaging to 2 years has documented exclusion of the pseudoaneurysm with no hemoptysis or signs of new false aneurysm formation.


CONCLUSIONS
Endovascular exclusion of anastomotic pseudoaneurysms even in complicated cases can be an efficient treatment option, but the procedure must be carefully planned and executed in order to achieve good results.
Smayra
T
T
Department of Radiology, Hôpital Rangueil, Toulouse, France.
Otal
P
P
Soula
P
P
Chabbert
V
V
Cérène
A
A
Joffre
F
F
Rousseau
H
H
D000714:Anastomosis, Surgical; D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000209:etiology*; D001017:Aortic Coarctation / Q000150:complications* / Q000601:surgery*; D001983:Bronchial Fistula / Q000175:diagnosis / Q000209:etiology*; D003937:Diagnosis, Differential; D006469:Hemoptysis / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D014057:Tomography, X-Ray Computed; D016157:Vascular Fistula / Q000175:diagnosis / Q000209:etiology*; D014656:Vascular Surgical Procedures / Q000295:instrumentation