Aortobronchial fistula in the presence of a midgraft hole after endovascular repair of thoracic aortic aneurysms

Abstract

Aortobronchial fistulas (ABF) are infrequent and require urgent diagnosis, often relying on a bundle of arguments. Thoracic endovascular aortic repair (TEVAR) is a possible therapeutic approach that needs close surveillance because its durability in such situations remains uncertain. We report a case of haemoptysis related to an aortobronchial fistula recurring 6 years after TEVAR, with an intraoperative finding of a midgraft hole. The patient underwent open repair with in situ aortic replacement with an aortic cryopreserved homograft.

Recurrent Aortobronchial Fistula after Endovascular Stenting for Infected Pseudoaneurysm of the Proximal Descending Thoracic Aorta: Case Report

“…Whether local infections and inf lammations can be completely resolved when an endoprosthesis is placed within the infected field is unknown. Remnant ABF, bron-chial and/or aortic wall erosion, the vasa vasorum connected with the ABF, and recurrent local inflammation of the thin aortic wall around ABF might cause recurrent hemoptysis [9,10]. The images of our present case may demonstrate the potential instability of ABF induced by an infected pseudoaneurysm and the surrounding tissues after TEVAR.…”

“…However, the long-term durability of stent grafts remains unknown. Concerns about the risk of the recurrence of ABF or infection of the stent graft have been raised [7][8][9]. Canaud et al [4] reported that recurrence of ABF and stent graft infections after TEVAR were observed in 11.2% and 1.7% of patients, respectively.…”

“…Surgical conversion was required in 4.3% of the patients [4][5][6][7]. In cases of ABF resulting from an infected pseudoaneurysm, an infectious break in the wall of an artery with the formation of a saccular outpouching and concomitant systemic infection may aggravate the outcomes after TEVAR [9,10]. In conclusion, including the patient described here from our institution, a recent body of literature points toward the conclusion that the early outcomes of TEVAR are excellent compared to the outcomes of open surgical intervention; however, the mid-term recurrence rate of ABF after TEVAR may be not acceptable [3].…”