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J Thorac Cardiovasc Surg 2007;133:1277-1285
© 2007 The American Association for Thoracic Surgery

Evolving Technology

Have we gone too far? Endovascular stent-graft repair of aortobronchial fistulas

^a Department of Cardiovascular and Endovascular Surgery, Arizona Heart Institute, Phoenix, Ariz
^b HeartCare Midwest, S.C., Peoria, Ill.

Presented at the Thirty-second Annual Meeting of the Western Thoracic Surgical Association, Sun Valley Resort, Sun Valley, Idaho, June 21–24, 2006.

Received for publication July 3, 2006; revisions received October 27, 2006; accepted for publication November 6, 2006.

^_* Address for reprints: Grayson H. Wheatley III, MD, Arizona Heart Institute, 2632 N. 20th Street, Phoenix, AZ 85006. (Email: GWheatley{at}azheart.com).

Objective: Although endovascular repair of the descending thoracic aorta has emerged as a viable treatment option, little is known about its potential to treat patients diagnosed with aortobronchial fistulas. We reviewed our comprehensive thoracic endografting experience with regard to the endovascular management and subsequent outcome of patients with aortobronchial fistulas to assess whether endoluminal graft repair is a realistic option.

Methods: Between February 2000 and November 2005, 255 patients were successfully treated with an endoluminal graft to the descending thoracic aorta. Indications for intervention included: atherosclerotic aneurysms (109/255, 42.7%), acute and chronic dissections (75/255, 29.4%), miscellaneous (34/255, 13.3%), penetrating aortic ulcers (30/255, 11.8%), and aortobronchial fistulas (7/255, 2.7%).

Results: Average patient age was 73.4 ± 10.1 years, with 4 male patients (4/7, 57.1%) and 3 female patients (3/7, 42.9%). All patients presented with hemoptysis, with 1 patient (1/7, 14.3%) requiring preoperative blood transfusion. Three patients (3/7, 42.9%) were diagnosed with atherosclerotic aneurysms, 3 patients (3/7, 42.9%) had pseudoaneurysms associated with prior open surgical repair, and 1 patient (1/7, 14.3%) had a prior endoluminal graft placed for a traumatic aortic transection. No standard postoperative antibiotic regimen was followed. There were no endoleaks, no incidences of paraplegia, and no endoluminal graft infections. Survival was 100% (7/7) at both 30 days and 1 year, and all patients are currently alive. Follow-up computed tomography was available for all 7 patients, with an average follow-up of 42.6 ± 28.5 months.

Conclusions: Endovascular management of aortobronchial fistulas appears to be safe and well tolerated, even in surgically high-risk patients, with minimal risk of prosthesis infection. Long-term surveillance and continued investigation are warranted.

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Discussion
J. Thorac. Cardiovasc. Surg. 2007 133: 1283-1285. [Extract] [Full Text] [PDF]

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