Endovascular stent-graft repair of aortobronchial fistulas.
BACKGROUND
Endovascular repair of the descending thoracic aorta has recently emerged as a feasible treatment option; however, little is known about its application for aortobronchial fistula (ABF). Experience with endovascular repair of the thoracic aorta and the outcome of patients with ABFs was reviewed to assess whether thoracic endovascular repair is a realistic option.


METHODS
From February 2001 to May 2011, 386 patients were successfully treated with endoluminal grafts to the distal arch or descending thoracic aorta. Among them, 26 patients with ABF underwent thoracic endovascular repair. These cases were reviewed and analyzed retrospectively. Follow-up was 100% complete (mean, 21 months).


RESULTS
The subjects included 26 patients (22 males, 85%; 4 females, 15%) with a median age of 71 years. Ten patients (38%) were diagnosed with atherosclerotic aneurysms, 13 (50%) had pseudoaneurysms associated with prior open surgical repair, 1 (4%) had rupture of dissecting aneurysm, and 2 (8%) had mycotic aneurysm. There were 4 (15%) in-hospital mortalities, in which the causes included bleeding owing to recurrence of hemoptysis (n=3, 11%) and multiple organ failure (n=1, 4%). None sustained postoperative stroke or paraplegia. During follow-up, ABFs recurred in 4 patients; of these, endograft explantation occurred in 3 patients and 1 patient required additional open surgery. No hospital mortality resulted among the 4 patients with ABF recurrence.


CONCLUSIONS
Endovascular management of ABFs appears to be safe and well tolerated with minimal risk, even in surgically high-risk patients. Endovascular stent-graft repair is likely the first choice for ABF presenting as hemoptysis.
Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan. nobuyosh@sapmed.ac.jp
Nobuyoshi
N
Kawaharada
Yoshihiko
Y
Kurimoto
Toshiro
T
Ito
Mayuko
M
Uehara
Toshiyuki
T
Maeda
Tetsuya
T
Koyanagi
Satoshi
S
Muraki
Atsushi
A
Watanabe
Tetsuya
T
Higami
D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery*; D001983:Bronchial Fistula / Q000601:surgery*; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016157:Vascular Fistula / Q000601:surgery*