Aortic Arch Replacement and Autologous Pericardial Tracheal Patch for an Aorto-Tracheal Fistula

Abstract

Aorto-tracheal fistulas are rare and highly lethal, with few reports of successful surgical intervention. We present a 48 year old man with aorto-tracheal fistula induced by radiation therapy for tracheal squamous cell carcinoma. He presented with hemoptysis and chest pain and workup revealed the aorta-tracheal fistula between the posterior aortic arch and anterior distal trachea. He was emergently taken to surgery. To our knowledge, this is the first report of an aorto-tracheal fistula successfully treated with a transverse aortic arch replacement and complex tracheal repair using autologous pericardium with an omental buttress.

Too big to fail?—An aggressive strategy for a dire problem

“…It seems that the procedure could be readily utilized in the appropriate patient. The authors perform an ascending and arch replacement with innominate artery debranching using hypothermic circulatory arrest, antegrade cerebral perfusion, and both antegrade and retrograde cardioplegia 2 …”

“…Musgrove et al 2 report a unique case in which a 48‐year‐old patient presents with small volume hemoptysis in the setting of prior radiation. Bronchoscopy revealed a small defect in the trachea near the carina.…”

“…However, when faced with a larger defect, or where infected aortic tissue spans the takeoff of the great vessels, a total arch replacement may be necessary. In the particular presentation described by Musgrove et al, 2 their technique of repair is not only large in both size and scope but also appropriate for the given pathology.…”

“…The authors perform an ascending and arch replacement with innominate artery debranching using hypothermic circulatory arrest, antegrade cerebral perfusion, and both antegrade and retrograde cardioplegia. 2 Three concerns arise in this type of case, touched on by the authors. First, the defect in the aorta.…”