pubmed.ncbi.nlm.nih.gov

Who needs their descending thoracic aorta anyway? Extra-anatomic bypass for aorto-bronchial fistula after TEVAR - PubMed

  • ️Sun Jan 01 2023

Case Reports

Who needs their descending thoracic aorta anyway? Extra-anatomic bypass for aorto-bronchial fistula after TEVAR

Joshua S Newman et al. J Cardiothorac Surg. 2023.

Abstract

Background: Aortobronchial fistula after TEVAR remains a vexing clinical problem associated with high mortality. Although a combination of endovascular and open surgical strategies have been reported in managing this pathology, there is as yet no definitive treatment algorithm that can be used for all patients. We discuss our approach to an aortobronchial fistula associated with an overtly infected aortic endograft.

Case presentation: A 49-year-old female sustained a traumatic aortic transection 14 years prior, managed by an endovascular stent-graft. Due to persistent endoleak, she underwent open replacement of her descending thoracic aorta 4 years later. Ten years after her open aortic surgery, the patient presented with hemoptysis, and a pseudoaneurysm at her distal aortic suture line was identified on computed tomography, whereupon she underwent placement of an endograft. Eight weeks later, she presented with dyspnea, recurrent hemoptysis, malaise and fever, with clinical and radiographic evidence of an aortobronchial communication and an infected aortic stent-graft. The patient underwent management via a two-stage open surgical approach, constituting an extra-anatomic bypass from her ascending aorta to distal descending aorta and subsequent radical excision of her descending aorta with all associated infected prosthetic material and repair of the airway.

Conclusion: Aortobronchial fistula after TEVAR represents a challenging complex clinical scenario. Extra-anatomic aortic bypass followed by radical debridement of all contaminated tissue may provide the best option for durable longer-term outcomes.

Keywords: Aortobronchial fistula; Descending thoracic aorta; Extra-anatomic; Hemoptysis; TEVAR.

© 2023. BioMed Central Ltd., part of Springer Nature.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1

A CT image demonstrating air adjacent to the endograft within the descending thoracic aorta (red arrow). B A defect in the wall of the left main bronchus with fibrino-purulent exudate is visible at flexible bronchoscopy (yellow arrow)

Fig. 2
Fig. 2

A prosthetic graft (blue arrow) extends from the ascending aorta, inferiorly around the right ventricle, to touch down at the distal descending thoracic aorta, just above the diaphragm. A separate extra-anatomic graft (yellow arrow) arises from the neo-aorta and is anastomosed to the left axillary artery

Fig. 3
Fig. 3

A diagrammatic representation of the patient’s new anatomy, comprising an extra-anatomic graft from the ascending aorta to the distal descending thoracic aorta, and a separate graft to the left axillary artery

Fig. 4
Fig. 4

The excised descending aorta, including previous surgical graft and more recently implanted endograft within

Similar articles

Cited by

References

    1. MacIntosh EL, Parrott JC, Unruh HW. Fistulas between the aorta and tracheobronchial tree. Ann Thorac Surg. 1991;51(3):515–519. doi: 10.1016/0003-4975(91)90888-W. - DOI - PubMed
    1. Yuan SM. Aortobronchial fistula. Gen Thorac Cardiovasc Surg. 2020;68(2):93–101. doi: 10.1007/s11748-019-01271-8. - DOI - PubMed
    1. Dorweiler B, Weigang E, Duenschede F, Pitton MB, Dueber C, Vahl CF. Strategies for endovascular aortic repair in aortobronchial and aortoesophageal fistulas. Thorac Cardiovasc Surg. 2013;61(7):575–580. doi: 10.1055/s-0033-1347294. - DOI - PubMed
    1. Macmanus Q, McCabe T, Spier AM. Aorto-bronchial fistula 14 years after repair of aortic transection: case report. Va Med. 1987;114(6):356–357. - PubMed
    1. Chiesa R, Melissano G, Marone EM, Marrocco-Trischitta MM, Kahlberg A. Aorto-oesophageal and aortobronchial fistulae following thoracic endovascular aortic repair: a national survey. Eur J Vasc Endovasc Surg. 2010;39(3):273–279. doi: 10.1016/j.ejvs.2009.12.007. - DOI - PubMed

Publication types

MeSH terms

LinkOut - more resources