Thoracic endovascular aortic repair of aortobronchial fistulas

Riesenman, Paul J.; Brooks, James D.; Farber, Mark A.

doi:10.1016/j.jvs.2009.03.001

Cited by 46 publications

(37 citation statements)

References 35 publications

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“…213,[256][257][258] Aortobronchial fistula can occur in association with MA, atherosclerotic aneurysm, trauma, or other causes. [256][257][258] Clinically, these patients present with sepsis and hemoptysis that may be intermittent or massive with possible exsanguination. There are no specific diagnostic tests, but aortobronchial fistula should be suspected in patients with underlying risk factors, sepsis, and hemoptysis.…”

Section: Additional Factors In Management Of Aortic Mamentioning

confidence: 99%

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

355

307

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The use of synthetic material for reconstructive vascular surgery was first reported during the early 1950s. Infection involving vascular graft prostheses is an infrequent but devastating complication of reconstructive vascular graft surgery and is associated with a high morbidity and, in some situations, mortality. Improvements in surgical techniques and graft design, including the use of native venous or arterial tissue, have reduced the frequency of infection and severity of complications from vascular graft infection (VGI). However, these advances have also led to more frequent vascular graft procedures occurring in a patient population with multiple underlying comorbidities that would have previously disqualified them as candidates for vascular reconstructive surgery. Underlying comorbidities, such as diabetes mellitus or immune compromise, increase the risk of infection and serious infection-related complications. The major complications of VGI include sepsis, amputation, disruption of infected anastomotic suture line with rupture or pseudoaneurysm formation, embolization of infected thrombi, reinfection of reconstructed vascular grafts, enteric fistulae to the small or large bowel, bacteremic spread of infection to other sites, and death. VGIs can be categorized broadly into those that occur in an extracavitary location, primarily in the groin or lower extremities, or in an intracavitary location, primarily within the abdomen or less commonly within the thorax. frequencyThe frequency of VGI depends on the anatomic location of the graft. The infection rate is 1.5% to 2% for most extracavitary grafts and as high as 6% with vascular grafts in the groin. [1][2][3][4][5][6][7][8][9] For intracavitary grafts, the infection rate is ≈1% to 5%. 1-6 Graft infection is most common after emergency procedures and after reoperation. [1][2][3][4]10 Aortic graft erosion or fistulous communication into the duodenum or other areas of the bowel reportedly occurs in 1% to 2% of patients after aortic reconstruction. 11,12 MicrobiologyThe microbiological cause of VGI has evolved over the years. 1 In early published studies, Staphylococcus aureus was the predominant microorganism recovered. 1,13 Improvements in surgical technique, administration of prophylactic antistaphylococcal antimicrobial therapy, and other factors have resulted in a changing microbiological epidemiology. Vascular graft surgery performed on patients with multiple underlying comorbidities and the increased frequency of emergency procedures have contributed to the changing spectrum of infection. Other factors such as changes in hospital flora, surgery in patients with complicated vascular anatomy, and multiple revisions of previous vascular surgery have resulted in a more diverse microbio- clInIcal stateMents anD GuIDelInes logical spectrum of infection, which includes multidrugresistant strains, polymicrobial infection, and Candida species. Gram-positive cocci accounts for at least two thirds of VGIs. 1,13 Infections caused by coagulase-negative staphylococ...

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Section: Additional Factors In Management Of Aortic Mamentioning

confidence: 99%

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

355

307

View full text Add to dashboard Cite

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“…The most common systemic pathologies resulting in sudden death are cardiovascular and pulmonary pathologies (11). Massive hemoptysis (bleeding at an amount>300-500 ml/24 hours or at a rate>100 ml/hour) is relatively rare in ABF, however it is responsible for a high death rate (3,6). The information regarding how much blood our case lost before taken to hospital is missing.…”

Section: Discussionmentioning

confidence: 99%

Death due to Aortobronchial Fistula Related Massive Hemoptysis a Case Report

Özsoy¹,

Alkan²,

Pehlivan³

et al. 2016

Bull Leg Med

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Aortobronchial fistulas are relatively rare but usually fatal if not treated since they might cause massive hemoptysis. Here we present a case of death of a 17-year-old male due to massive hemoptysis secondary to aortobronchial fistula. The deceased was firstly admitted to an emergency department with dyspnea, tachypnea, tachycardia, resistant metabolic acidosis, confusion, and somnolence. He was diagnosed with “diabetic ketoacidosis” following examinations; however, detailed radiological and clinical investigations revealed community-acquired infection findings and medical treatment was started accordingly. He was discharged after 15 days of hospitalization; however, he died unexpectedly 12 days after discharge.At autopsy a 4-cm aortobronchial fistula was found between the thoracic aortic wall and the left main bronchus. Histopathological examination of fistula showed diffuse and intense necro-inflammatory reaction and inflammatory response with polymorphonuclear leukocytes and necrosis. Death was attributed to massive hemoptysis and blood aspiration due to aortobronchial fistula.A feedback system, towards healthcare centers, based on autopsy findings and exact cause and mechanisms of death will contribute improvement of diagnosis and treatment approach.Keywords: Aortopulmonary fistula; Respiratory Tract Fistula; Bronchial Fistula; Vascular Fistula; Hemoptysis; Cannabinoids; Autopsy.

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“…Hasta la última década, el tratamiento de las fístulas aortobronquiales ha sido la cirugía convencional, con la práctica de una toracotomía izquierda, reparación aórtica, exclusión del trayecto fistuloso y la eventual resección pulmonar atípica. Las cifras de morbimortalidad comunicadas se basan sólo en pequeñas series de pacientes, pero se acepta en términos generales una mortalidad entre el 13 y el 30% tras la reparación quirúrgica, a largo plazo (1,11). La terminación aórtica de la fístula puede ser tratada por cierre simple, parche protésico o injerto protésico, y si la infección está presente la mejor opción es un homoinjerto (3) .…”

Section: Discussionunclassified