Stent-graft repair of aortobronchial fistula: a review.
OBJECTIVE
To evaluate the role of aortic stent-graft implantation in managing aortobronchial fistula (ABF).


METHODS
A search of the Medline, EMBASE, and Cochrane databases for studies reporting on ABF treated with stent-grafts from 1996 to 2008 retrieved 44 articles with data on 82 ABFs. Most (57 ABFs) were published in 30 case reports; the others were retrieved from 14 acute aortic series.


RESULTS
In the perioperative period, 4 (4.9%) deaths (3 from hemorrhage) were reported, but no paraplegia/stroke. Local graft-related complications were more common, including arm ischemia (n = 4) and iliac ruptures (n = 3). Long-term data were available for only a few studies. Recurrent hemorrhage (14%) occurred from 2 weeks to 9 years after repair. Reinterventions to manage recurrences were generally based on redo endografting.


CONCLUSIONS
A contaminated field and the emergency setting make stent-graft repair of ABFs challenging. After successful stent-graft deployment, the risks of recurrence and mortality are concerning. One can infer from the data that endografting might be a reasonable temporary bridge solution, but potentially unstable in the long term. Open repair likely will remain indicated once the patient has been stabilized physiologically with emergent stent-graft repair.
De Rango
Paola
P
Division of Vascular and Endovascular Surgery, University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy.
Estrera
Anthony L
AL
Azizzadeh
Ali
A
Safi
Hazim J
HJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D001983:Bronchial Fistula / Q000401:mortality / Q000601:surgery*; D018795:Device Approval; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology; D012008:Recurrence; D012086:Reoperation; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000401:mortality / Q000601:surgery*