IP061. Case Report: Treatment of Juxtarenal Aortic Coral Reef Lesion With Aortic Eversion Endarterectomy

Abstract

Objectives: We describe a novel adjunctive treatment for aortobronchial fistulas.Methods: A foam sclerosing compound consisting of sodium tetradecyl sulfate (STS), lipiodol, and air has been successfully used in the treatment of bleeding gastric varices. We describe a 65-year-old cirrhotic patient with a saccular aortic arch aneurysm who required emergency treatment for a symptomatic aortobronchial fistula. The patient originally presented with a contained rupture of a thoracic aortic aneurysm and underwent urgent placement of a thoracic aortic stent graft. Postoperatively, he developed significant hemoptysis due to an aortobronchial fistula. A chest computed tomography demonstrated a proximal type I endoleak with enlargement of the aneurysmal sac. With the patient deemed not a candidate for open surgical repair, we chose to reinforce the proximal endograft seal zone with a Palmaz stent and ablation of the aneurysm sac with STS/lipiodol foam. The patient recovered from the procedure well and, thereafter, was no longer symptomatic.Results: Thrombosis of the thoracic aneurysm sac and ablation of the aortobronchial fistula led to cessation of bleeding symptoms.Conclusions: In selected cases, sterile STS/lipiodol foam ablation is a potential adjunct to TEVAR for treating symptomatic aortobronchial fistulas.