Endoluminal stent-graft repair of aortobronchial fistulas: bridging or definitive long-term solution?
OBJECTIVE
To describe our experience with endoluminal stent-graft repair of aortobronchial fistulas (ABF) and to analyze midterm results focusing on late chronic graft infections, secondary conversion, and survival.


METHODS
The records of 8 patients (6 men; mean age 69 years, range 28-88) treated between March 1997 and October 2003 for traumatic and postsurgical ABFs were reviewed. Seven presented with hemoptysis and 1 with hemorrhagic shock. According to the severity of emergency, patients underwent computed tomography, angiography, bronchoscopy, and transesophageal echocardiography. Preoperatively, no clinical signs of infection were evident. Two different stent-graft models (Talent and Excluder) were implanted using standard endovascular techniques.


RESULTS
Procedural and clinical success was achieved in all patients. Paraplegia, secondary intervention, conversion, or procedure-related death was not observed. Mean follow-up was 30 months (range 0.6-77). One patient with a postsurgical ABF (Dacron tube graft) successfully treated with an Excluder stent-graft died 13 months later from hemorrhage secondary to aortoesophageal fistula repair procedures. A second patient died from pneumonia after 42 months. A third patient, in whom 2 Talent stent-grafts had been implanted to treat an ABF from the false lumen of a type B dissection, died 7 months later from massive hemorrhage.


CONCLUSIONS
Endoluminal stent-grafting of ABF is feasible and the preferred method of treatment. Secondary conversion due to endograft infection is not absolutely mandatory, but close surveillance is necessary.
Böckler
Dittmar
D
Department of Vascular and Endovascular Surgery, Ruprecht-Karls University Heidelberg, Germany. dittmar_boeckler@med.uni-heidelberg.de
Schumacher
Hardy
H
Schwarzbach
Matthias
M
Ockert
Stefan
S
Rotert
Harald
H
Allenberg
Jens-Rainer
JR
D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D001983:Bronchial Fistula / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections; D015607:Stents; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000601:surgery*