title: Surgical treatment of aortobronchial and aortoesophageal fistulae due to thoracic aortic aneurysm.
abstract: We present a review of our single-institution experience, over 19 years, with aortobronchial and aortoesophageal fistulae due to descending thoracic aortic aneurysm. We conducted a retrospective chart review of 10 cases involving surgery for aortobronchial and aortoesophageal fistulae in our clinic from February 1985 through October 2004. Pathologic or predisposing conditions associated with aortobronchial fistula were descending thoracic aortic aneurysm (n=8), previous aortic surgery (n=1), and concomitant aortoesophageal fistula (n=1). Three patients presented emergently with aortobronchial fistula (n=2) and aortoesophageal fistula (n=1). Ages of the 10 patients ranged from 42 to 74 years (median, 63 years). The median cross-clamp time was 34 minutes (range, 27-41 min). Repairs, in 9 patients, involved an inlay of prosthetic tube graft using the clamp-and-sew technique, and in 1 patient repair involved patch aortoplasty. The operative mortality rate was 20%:1 patient had acute concomitant aortoesophageal and aortobronchial fistulae, and another had chronic aortobronchial fistula. There was no embolic stroke or paraplegia. During follow-up (median, 2.5 years), there were no deaths or postoperative morbidity We conclude that repair of aortobronchial and aortoesophageal fistulae using the clamp-and-sew technique can be performed with acceptable operative mortality and long-term results. However, the mortality rate continues to be highly significant in patients with acute bleeding aortobronchial fistula or with aortoesophageal fistula, despite rapid surgical intervention.
authors.affiliation: Department of Cardiovascular Surgery, Kosuyolu Heart and Research Hospital, Istanbul 34718, Turkey. erenerus@yahoo.com
authors.forename: Ercan
authors.initials: E
authors.lastname: Eren
authors.forename: Cuneyt
authors.initials: C
authors.lastname: Keles
authors.forename: Mehmet Erdem
authors.initials: ME
authors.lastname: Toker
authors.forename: Suat
authors.initials: S
authors.lastname: Ersahin
authors.forename: Vedat
authors.initials: V
authors.lastname: Erentug
authors.forename: Mustafa
authors.initials: M
authors.lastname: Guler
authors.forename: Gokhan
authors.initials: G
authors.lastname: Ipek
authors.forename: Esat
authors.initials: E
authors.lastname: Akinci
authors.forename: Mehmet
authors.initials: M
authors.lastname: Balkanay
authors.forename: Cevat
authors.initials: C
authors.lastname: Yakut
mesh_terms: D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic; D001018:Aortic Diseases / Q000175:diagnosis / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D001983:Bronchial Fistula / Q000175:diagnosis / Q000601:surgery*; D004937:Esophageal Fistula / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D013536:Suture Techniques; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000175:diagnosis / Q000601:surgery*