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Tinica G, Tarus A, Bacusca A, Chistol RO, Rusu AC, Todosia MT, Furnica C. Hybrid Management of an Aortobronchial Fistula after Patch Aortoplasty for Aortic Coarctation in a Patient with SARS-CoV-2 Pneumonia: Case Report and Review of the Literature. Medicina (B Aires) 2022; 58:medicina58101385. [PMID: 36295547 PMCID: PMC9610690 DOI: 10.3390/medicina58101385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/20/2022] [Accepted: 09/29/2022] [Indexed: 11/13/2022] Open
Abstract
Aortobronchial fistula is a rare cause of repeated hemoptysis and a potentially fatal condition if left untreated. We present the case of a 40-year-old man with repeated hemoptysis, excessive cough, and epistaxis ongoing for several days after SARS-CoV-2 pneumonia diagnosis. The patient had a history of patch aortoplasty for aortic coarctation and aortic valve replacement with a mechanical valve for aortic insufficiency due to bicuspid aortic valve at the age of 24. Computed tomography scan performed at presentation revealed a severely dilated ascending aorta, a thoracic aorta pseudoaneurysm at the site of the former coarctation, an aortobronchial fistula suggested by the thickened left lower lobe apical segmental bronchus in contact with the pseudoaneurysm and signs of alveolar hemorrhage in the respective segment. The patient was treated with thoracic endovascular aneurysm repair (TEVAR) after prior hemi-aortic arch debranching and transposition of the left common carotid artery and subclavian artery through a closed-chest surgical approach. Our case report together with a systematic review of the literature highlight the importance of both considering an aortobronchial fistula in the differential diagnosis of hemoptysis in patients with prior history of thoracic aorta surgical intervention, regardless of associated pathology, and of taking into account endovascular and hybrid techniques as an alternative to open surgical repair, which carries a high risk of morbidity and mortality.
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Affiliation(s)
- Grigore Tinica
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Cardiovascular Diseases Institute, 700503 Iasi, Romania
| | - Andrei Tarus
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Cardiovascular Diseases Institute, 700503 Iasi, Romania
| | - Alberto Bacusca
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Cardiovascular Diseases Institute, 700503 Iasi, Romania
| | - Raluca Ozana Chistol
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Cardiovascular Diseases Institute, 700503 Iasi, Romania
- Correspondence: (R.O.C.); (A.C.R.)
| | - Alexandra Cristina Rusu
- Department of Ophthalmology, Targu Mures County Hospital, 540072 Targu Mures, Romania
- Doctoral School of Medicine and Pharmacy, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, 540139 Targu Mures, Romania
- Correspondence: (R.O.C.); (A.C.R.)
| | - Mihaela Tomaziu Todosia
- Department of Institutional Development, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Research Center in Management, Alexandru Ioan Cuza University, 11 Carol I Blvd., 700506 Iasi, Romania
| | - Cristina Furnica
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Institute of Forensic Medicine, 700455 Iasi, Romania
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Anastasiadou C, Trellopoulos G, Kastora S, Kakisis I, Papapetrou A, Galyfos G, Geroulakos G, Megalopoulos A. A systematic review of therapies for aortobronchial fistulae. J Vasc Surg 2021; 75:753-761.e3. [PMID: 34624495 DOI: 10.1016/j.jvs.2021.08.108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 08/22/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of the study was to summarize epidemiologic data about aortobronchial fistulas and compare outcomes (mortality, recurrence, re-operation) of open, staged, and endovascular repair of aortobronchial fistula. METHODS A systematic literature review was conducted to identify eligible studies published between January of 1999 and December of 2019. The Cochrane Library, PubMed and Scopus databases were used as search engines. Eligible studies included articles reporting postoperative outcomes (death/follow-up). Literature review revealed only case reports and small case series and thus, only descriptive data with data heterogeneity was available. The corresponding authors were contacted to provide additional information or outcome updates (recurrence/reoperation/death). RESULTS Overall, 214 patients (90 studies) underwent 271 procedures (including re-do procedures and staged procedures). Most of the patients were treated by endovascular means (72.42%). Open surgical repair was performed in 21.96% and staged procedures in 5.6%. Aortobronchial fistulae located most often in the descending thoracic aorta (Zone 3,4) (64,6%) and in Zone 2 (23,8%). Fourteen percent of aortobronchial fistulae developed after thoracic endovascular aneurysm repair. Recurrence or infection occurred in 20% (43 patients). Recurrences were at some extend associated with the presence of endoleak. Long-term antibiotic administration (>1 month) was instituted in 63 patients (29.4%), whilst 90 patients (42%) did not receive antibiotics beyond hospitalization. From the remaining 61, 3 received life-long antibiotics and for 58 patients data were not available. Considering outcomes, mean follow-up was 25.1 months (0-188 months) and not significantly different among treatments. LIMITATIONS Literature review has revealed only case reports and small case series and thus, only descriptive data were available. Randomized controlled trials are not available due to the rarity of the disease which significantly decreases the power of the present study. Also, this study reflects significant data heterogeneity due to the nature of the analyzed manuscripts and would benefit from large patient cohort studies which till today have not been conducted. CONCLUSION Aortobronchial fistula is a complex disease. Endoleaks may be involved in the development and in recurrence process and they should not be disregarded. Considering major outcomes (length of follow-up), the available treating strategies are equal and thus, surgeons should feel confident to apply the treatment of their choice, taking in mind their experience, patient's age, and clinical condition.
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Affiliation(s)
| | - George Trellopoulos
- Department of Vascular Surgery - General Hospital of Thessaloniki "Georgios Papanikolaou"
| | | | - Ioannis Kakisis
- Department of Vascular Surgery -"Attikon" University Hospital, Medical School, National and Kapodistrian University of Athens
| | | | - George Galyfos
- Department of Vascular Surgery - General Hospital of Attica "KAT"
| | - George Geroulakos
- Department of Vascular Surgery -"Attikon" University Hospital, Medical School, National and Kapodistrian University of Athens
| | - Angelos Megalopoulos
- Department of Vascular Surgery - General Hospital of Thessaloniki "Georgios Papanikolaou"
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Omran S, Ardalani L, Beyer K, De Bucourt M, Gombert A, Buerger M, Frese JPB, Greiner A. Management of Tumor- and Nontumor-related Aorto-esophageal and Aorto-bronchial Fistulas. Ann Vasc Surg 2020; 72:419-429. [PMID: 33227472 DOI: 10.1016/j.avsg.2020.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/27/2020] [Accepted: 10/06/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND This study aims to review and compare the clinical presentation, management, and outcome in patients with tumor-related (TR) and nontumor-related (NTR) aorto-esophageal fistula (AEF) and aorto-bronchial fistula (ABF) with particular focus on the thoracic endovascular aortic repair. METHODS We retrospectively reviewed a series of 16 consecutive patients with TR (n = 8) and NTR (n = 8), ABF (n = 6), and AEF (n = 10) admitted to our hospital from 2011 to 2019. RESULTS The median age was 62 years (range 46-81), with 11 men. The most common predisposing factor was esophageal or gastric cardia cancer (n = 6), followed by open repair of the thoracic aorta (n = 5). Endoluminal vacuum therapy (Endo-SPONGE®) accounted for 3 cases of AEFs. Thoracic endovascular aortic repair (TEVAR) was applied in 13 patients (4 with ABFs and 9 with AEFs). The primary technical success of the TEVARs was 100%. One patient (8%) was complicated with postoperative middle cerebral artery syndrome and left-sided hemiparesis. The respective in-hospital, 6-month, and 1-year mortality rates were 0% (n = 0), 25% (n = 2), and 25% (n = 2) for the NTR group and 63% (n = 5), 88% (n = 7), and 100% (n = 8) for the TR group. After a mean period of 13 months, 5 (31%) patients were still alive, and one patient lost to follow-up after 11 months. The survivors (n = 5) had all nontumor-related ABF. Progression of underlying cancer and hemodynamic shock were the most common causes of death. CONCLUSIONS TEVAR represents a reliable option in the treatment of NTR ABFs. In the cases of TR fistulas and NTR AEFs, TEVAR should be applied more selectively. The associated mortality remains very high.
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Affiliation(s)
- Safwan Omran
- Charité - Universitätsmedizin Berlin, Clinic of Vascular Surgery, Campus Benjamin Franklin, Berlin, Germany.
| | - Lavinia Ardalani
- Charité - Universitätsmedizin Berlin, Clinic of Vascular Surgery, Campus Benjamin Franklin, Berlin, Germany
| | - Katharina Beyer
- Charité - Universitätsmedizin Berlin, Surgical Clinic, Campus Benjamin Franklin, Berlin, Germany
| | - Maximilian De Bucourt
- Charité - Universitätsmedizin Berlin, Department of Radiology, Campus Benjamin Franklin, Berlin, Germany
| | - Alexander Gombert
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Matthias Buerger
- Charité - Universitätsmedizin Berlin, Clinic of Vascular Surgery, Campus Benjamin Franklin, Berlin, Germany
| | - Jan Paul Bernhard Frese
- Charité - Universitätsmedizin Berlin, Clinic of Vascular Surgery, Campus Benjamin Franklin, Berlin, Germany
| | - Andreas Greiner
- Charité - Universitätsmedizin Berlin, Clinic of Vascular Surgery, Campus Benjamin Franklin, Berlin, Germany
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Canaud L, Ozdemir BA, Bahia S, Hinchliffe R, Loftus I, Thompson M. Thoracic Endovascular Aortic Repair for Aortobronchial Fistula. Ann Thorac Surg 2013; 96:1117-21. [DOI: 10.1016/j.athoracsur.2013.04.090] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 04/12/2013] [Accepted: 04/15/2013] [Indexed: 10/26/2022]
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Bailey CJ, Force S, Milner R, Kasirajan K, Veeraswamy RK. Thoracic endovascular repair as a safe management strategy for aortobronchial fistulas. J Vasc Surg 2011; 53:1202-9; discussion 1209. [DOI: 10.1016/j.jvs.2010.10.103] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Revised: 10/13/2010] [Accepted: 10/16/2010] [Indexed: 11/16/2022]
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Rodríguez-Caulo EA, Velázquez CJ, Barquero JM, García-Borbolla M. Atypical chest pain and hemoptysis 27 years after aortic coarctation surgery: aortobronchial fistula, management and endovascular treatment. Rev Esp Cardiol 2011; 64:726-7. [PMID: 21489674 DOI: 10.1016/j.recesp.2010.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Accepted: 11/06/2010] [Indexed: 11/15/2022]
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De Rango P, Estrera AL, Azizzadeh A, Safi HJ. Stent-Graft Repair of Aortobronchial Fistula: A Review. J Endovasc Ther 2009; 16:721-32. [DOI: 10.1583/09-2800.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Jonker FHW, Schlösser FJV, Moll FL, van Herwaarden JA, Indes JE, Verhagen HJM, Muhs BE. Outcomes of thoracic endovascular aortic repair for aortobronchial and aortoesophageal fistulas. J Endovasc Ther 2009; 16:428-40. [PMID: 19702348 DOI: 10.1583/09-2741r.1] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To identify in-hospital and follow-up outcomes of thoracic endovascular aortic repair (TEVAR) for aortobronchial fistula (ABF) and aortoesophageal fistula (AEF). METHODS The authors reviewed all published cases of ABF and AEF undergoing TEVAR indexed in the MEDLINE, Cochrane Library CENTRAL, and EMBASE databases. After removal of duplicates, 850 articles were scrutinized for relevance and validity. Exclusion criteria included: (1) no clear description of the organs involved with the fistula, (2) no description of outcomes after TEVAR for ABF or AEF, or (3) no original data presented in the article. In this manner, 66 relevant articles were identified that included original data on 114 patients (76 men; mean age 63+/-1.5 years) with ABF (n = 71) or AEF (n = 43). Meta-analyses were performed to investigate outcomes of TEVAR for ABF and AEF. RESULTS Patients with AEF presented more frequently with hypovolemic shock (33% versus 13%, p = 0.012) and systemic infection (36% versus 9%, p<0.001) compared to patients with ABF. In-hospital mortality was 3% (n = 2) after TEVAR for ABF and 19% (n = 8) after TEVAR for AEF (p = 0.004). Additional thoracic surgery in the first 30 days after TEVAR was performed in 3% (n = 2) of ABF patients and in 37% (n = 16) of AEF patients (p<0.001); 12 AEF patients who had received esophageal surgery in the first month after TEVAR showed lower fistula-related mortality during 6 months of follow-up compared to patients who did not receive additional esophageal surgery (p = 0.018). CONCLUSION TEVAR is associated with superior outcomes in patients with ABF. Endovascular management of AEF is associated with poor results and should not be considered definitive treatment. TEVAR could serve as a bridge to surgery for emergency cases of AEF only, with definitive open surgical correction of the fistula undertaken as soon as possible.
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Affiliation(s)
- Frederik H W Jonker
- Department of Surgery and Radiology, Yale University School of Medicine, New Haven, Connecticut, USA
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Riesenman PJ, Brooks JD, Farber MA. Thoracic endovascular aortic repair of aortobronchial fistulas. J Vasc Surg 2009; 50:992-8. [DOI: 10.1016/j.jvs.2009.03.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Revised: 03/05/2009] [Accepted: 03/06/2009] [Indexed: 11/27/2022]
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Hacker S, Langenberger H, Plank C, Gorlitzer M, Ehrlich M, Dolak W, Kreuzer S, Loewe C, Klepetko W, Ankersmit HJ. Management of aortobronchial fistula developing 27 years after open aortic surgery by means of endovascular stent grafting. J Thorac Cardiovasc Surg 2009; 139:778-80. [PMID: 19660361 DOI: 10.1016/j.jtcvs.2009.02.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Revised: 01/30/2009] [Accepted: 02/20/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Stefan Hacker
- Department of Surgery, Medical University of Vienna, 1090 Vienna, Austria
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Rodríguez-Morata A, Garrido-Jiménez J, Cuenca-Manteca J, Ros-Díe E. Tratamiento endovascular urgente de una fístula aortobronquial primaria. Presentación de un caso y revisión de la bibliografía. ANGIOLOGIA 2008. [DOI: 10.1016/s0003-3170(08)06005-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Picichè M, Demaria RG, Albat B. Endovascular repair of postoperative aortobronchopulmonary fistulas. J Thorac Cardiovasc Surg 2007; 133:1125. [PMID: 17382688 DOI: 10.1016/j.jtcvs.2006.10.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2006] [Accepted: 10/25/2006] [Indexed: 10/23/2022]
Affiliation(s)
- Marco Picichè
- Service de Chirurgie Cardio-Vasculaire, Chu Arnaud de Villeneuve, Montpellier, France
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