title: Endovascular repair as a bridge to surgical repair of an aortobronchial fistula complicating chronic residual aortic dissection.
abstract: Endovascular and open surgical repair have been used in patients with descending thoracic aortic dissection; however, the appropriate treatment is debated. We describe the case of a 60-year-old woman who had a symptomatic, chronic, residual, descending thoracic aortic dissection that was complicated by an aortobronchial fistula. She underwent emergent thoracic endovascular stent-grafting but remained symptomatic. Computed tomographic angiograms showed a contained rupture into the lower lobe of the left lung. The patient underwent definitive surgery to remove the stents, reconstruct the aorta, and resect the nonviable lung tissue. The remainder of her postoperative course was uneventful, and she was discharged from the hospital 13 days after the 2nd operation. Results of genetic testing confirmed an earlier presumptive diagnosis of Marfan syndrome. In an emergency, the best initial option for patients with a complicated descending thoracic aortic dissection might be thoracic endovascular aortic repair, which could serve as a bridge to definitive open repair.
authors.affiliation: Divisions of Vascular Surgery (Dr. Matos) and Cardiothoracic Surgery (Drs. Coselli, de la Cruz, LeMaire, Ouzounian, and Preventza), Michael E. DeBakey Department of Surgery, Baylor College of Medicine; and Department of Cardiovascular Surgery (Drs. Coselli, de la Cruz, LeMaire, Ouzounian, and Preventza), Texas Heart Institute; Houston, Texas 77030.
authors.forename: Jesus M
authors.initials: JM
authors.lastname: Matos
authors.affiliation: Divisions of Vascular Surgery (Dr. Matos) and Cardiothoracic Surgery (Drs. Coselli, de la Cruz, LeMaire, Ouzounian, and Preventza), Michael E. DeBakey Department of Surgery, Baylor College of Medicine; and Department of Cardiovascular Surgery (Drs. Coselli, de la Cruz, LeMaire, Ouzounian, and Preventza), Texas Heart Institute; Houston, Texas 77030.
authors.forename: Kim I
authors.initials: KI
authors.lastname: de la Cruz
authors.affiliation: Divisions of Vascular Surgery (Dr. Matos) and Cardiothoracic Surgery (Drs. Coselli, de la Cruz, LeMaire, Ouzounian, and Preventza), Michael E. DeBakey Department of Surgery, Baylor College of Medicine; and Department of Cardiovascular Surgery (Drs. Coselli, de la Cruz, LeMaire, Ouzounian, and Preventza), Texas Heart Institute; Houston, Texas 77030.
authors.forename: Maral
authors.initials: M
authors.lastname: Ouzounian
authors.affiliation: Divisions of Vascular Surgery (Dr. Matos) and Cardiothoracic Surgery (Drs. Coselli, de la Cruz, LeMaire, Ouzounian, and Preventza), Michael E. DeBakey Department of Surgery, Baylor College of Medicine; and Department of Cardiovascular Surgery (Drs. Coselli, de la Cruz, LeMaire, Ouzounian, and Preventza), Texas Heart Institute; Houston, Texas 77030.
authors.forename: Ourania
authors.initials: O
authors.lastname: Preventza
authors.affiliation: Divisions of Vascular Surgery (Dr. Matos) and Cardiothoracic Surgery (Drs. Coselli, de la Cruz, LeMaire, Ouzounian, and Preventza), Michael E. DeBakey Department of Surgery, Baylor College of Medicine; and Department of Cardiovascular Surgery (Drs. Coselli, de la Cruz, LeMaire, Ouzounian, and Preventza), Texas Heart Institute; Houston, Texas 77030.
authors.forename: Scott A
authors.initials: SA
authors.lastname: LeMaire
authors.affiliation: Divisions of Vascular Surgery (Dr. Matos) and Cardiothoracic Surgery (Drs. Coselli, de la Cruz, LeMaire, Ouzounian, and Preventza), Michael E. DeBakey Department of Surgery, Baylor College of Medicine; and Department of Cardiovascular Surgery (Drs. Coselli, de la Cruz, LeMaire, Ouzounian, and Preventza), Texas Heart Institute; Houston, Texas 77030.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Coselli
mesh_terms: D000784:Aortic Dissection / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D000792:Angiography / Q000379:methods; D001013:Aorta, Thoracic / Q000473:pathology / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D001983:Bronchial Fistula / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D002908:Chronic Disease; D020878:Device Removal / Q000379:methods*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D055370:Lung Injury; D008382:Marfan Syndrome / Q000150:complications; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D012086:Reoperation / Q000379:methods; D015607:Stents / Q000009:adverse effects; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
keywords: Acute disease; aorta, thoracic/pathology; aortic aneurysm, thoracic/complications/pathology/surgery/therapy; aortobronchial fistula/surgery; blood vessel prosthesis implantation; device removal; endovascular procedures/methods; postoperative complications; treatment outcome; vascular surgical procedures