J Thorac Cardiovasc Surg 2007;133:1125
© 2007 The American Association for Thoracic Surgery
Endovascular repair of postoperative aortobronchopulmonary fistulas
Marco Picichè, MD,
Roland G. Demaria, MD, PhD,
Bernard Albat, MD
Service de Chirurgie Cardio-Vasculaire, Chu Arnaud de Villeneuve, Montpellier, France
To the Editor:
We read with great interest the brief communication by Quintana and colleagues,1
and we congratulate their successful endovascular treatment of an aortobronchial fistula. Management of such fistulas is not easy. Diagnosis is difficult due to the rarity of this entity and because even modern preoperative investigations sometimes fail to directly visualize the fistula. Surgical treatment represents a real challenge due to coexistence of emergency conditions and difficulties of redo operations. In a collective review of the literature (to our knowledge the unique reporting specifically of postoperative aortic fistulas into the airways), which included all published cases from 1947 to October 2002, one of us (M.P.) found this complication in 76 patients, for a total of 79 fistulas (3 patients were affected by 2 fistulas).2 The review disclosed that 50 fistulas involving the descending thoracic aorta were treated by heterogeneous surgical procedures (primary, patch, or subclavian flap repair, graft replacement, homograft implant, extra-anatomic bypass graft), with a mortality rate of 16% and with most patients dying intraoperatively. Instead, there were no deaths related to procedure type, respectively, in 15 patients treated by stent grafts, in 1 patient managed by transcatheter embolization, and in 5 surgically treated cases involving the ascending aorta. Although in selected patients endovascular repair has been used as an emergency or palliative alternative to treat even primary fistulas due to atherosclerotic aneurysms3 or pulmonary infectious disease,4 we believe that its best indication lies in the late postoperative setting. Despite the potential infectious complications of stent grafts, we believe that the endovascular option to treat postoperative aortobronchial and aortopulmonary fistulas represents the appropriate solution because it avoids high morbidity and mortality rates of urgent redo operations.
References
- Quintana AL, Aguilar EM, Heredero AF, Riambau V, Paul L, Acin F, et al. Aortobronchial fistula after aortic coartactation. J Thorac Cardiovasc Surg 2006;131:240-243.[Free Full Text]
- Picichè M, De Paulis R, Fabbri A, Chiariello L. Postoperative aortic fistulas into the airways: etiology, pathogenesis, presentation, diagnosis and management. Ann Thorac Surg 2003;75:1998-2006.[Abstract/Free Full Text]
- Léobon B, Roux D, Mugniot A, Rousseau H, Cérene A, Glock Y, et al. Endovascular treatment of thoracic aortic fistulas. Ann Thorac Surg 2002;74:247-249.[Abstract/Free Full Text]
- Yoo JH, Lee CT, Shim YS, Chung JW, Ahn H, Kim KW. Aortobronchial fistula presenting as recurrent hemoptysis and successfully treated with an endovascular stent graft. Respiration 2001;68:537-539.[Medline]
