Endovascular repair of an aortopulmonary fistula via the axillary artery.
A 62-year-old man presented with several months of progressive hemoptysis. He has a history of aortobifemoral bypass and thoracofemoral bypass grafts, which were both removed due to infection. Evaluation with multiple imaging modalities revealed a descending thoracic aortic pseudoaneurysm around the retained Dacrontrade mark graft with bronchiectatic changes and consolidation of the adjacent left lower lobe. No evidence of direct arterial communication between the aorta and the bronchioles was ever demonstrated, but an aortopulmonary fistula was suspected. Endovascular repair with several Excluder aortic cuffs stacked in the thoracic aorta was successfully performed via the axillary artery. Exclusion of the pseudoaneurysm with no evidence of endoleak was noted on computed tomography 2 months postoperatively, at which time the patient reported complete resolution of his hemoptysis. To our knowledge, this is the first report of endovascular repair of an aortopulmonary fistula via the axillary artery.
Division of Cardiothoracic and Vascular Surgery, Scripps Clinic/Scripps Green Hospital, San Diego, CA, USA.
Leoncio L
LL
Kaw
Erik L
EL
Owens
Nikhil
N
Kansal
D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging; D001366:Axillary Artery; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D018450:Disease Progression; D006469:Hemoptysis / Q000209:etiology; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed