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Bozzay JD, Kneuertz PJ, Xu DS, Sarac TP, Bozinovski J, Orion KC. Staged complex reconstruction of infected thoracic aortic endograft and adjacent spinal hardware using latissimus wrapped lateral aortic graft. J Vasc Surg Cases Innov Tech 2024; 10:101596. [PMID: 39310917 PMCID: PMC11414663 DOI: 10.1016/j.jvscit.2024.101596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 07/22/2024] [Indexed: 09/25/2024] Open
Abstract
Thoracic endovascular aortic repair (TEVAR) enables rapid and effective treatment of life-threatening aortic injuries. The occurrence of long-term complications from TEVAR and their management is ill-defined in young patients. This report describes a complex case of a 38-year-old male patient who underwent staged interventions for different acute pathologies instigated by blunt thoracic spinal trauma. The patient was initially treated with a TEVAR for aortic pseudoaneurysm in the setting of infected spinal hardware, which later resulted in an aortobronchial fistula and eroded spinal hardware. This report illustrates a successful multidisciplinary approach for definitive treatment with graft explant and aortic reconstruction.
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Affiliation(s)
- Joseph D. Bozzay
- Division of Vascular Diseases and Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Peter J. Kneuertz
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - David S. Xu
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Timur P. Sarac
- Division of Vascular Diseases and Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - John Bozinovski
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Kristine C. Orion
- Division of Vascular Diseases and Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
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2
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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Melo RGE, Spath P, Stana J, Prendes CF, Stavroulakis K, Rantner B, Pichlmaier M, Tsilimparis N. Secondary Endovascular Conversions for Failed Open Repair. AORTA (STAMFORD, CONN.) 2023; 11:137-144. [PMID: 37949107 PMCID: PMC11038728 DOI: 10.1055/s-0043-1774724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 04/11/2023] [Indexed: 11/12/2023]
Abstract
Late aortic and graft-related complications after open aortic repair are not infrequent and a significant number of them are missed, diagnosed at a very late stage, or present as urgent complications such as aortic rupture or aorto-enteric fistula. Once a late complication is diagnosed and reintervention is necessary, both open and endovascular strategies are possible. Open reintervention is complex and usually associated with very high rates of morbidity and mortality. Endovascular techniques may offer several solutions for these cases, which may be tailored to the patient and specific complication. In this review, we aim to summarize current indications, options, and strategies for endovascular salvage after failed or complicated open surgical repair.
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Affiliation(s)
- Ryan Gouveia e Melo
- Vascular Surgery Department, Ludwig Maximilian University Hospital, Munich, Germany
| | - Paolo Spath
- Vascular Surgery Department, Ludwig Maximilian University Hospital, Munich, Germany
| | - Jan Stana
- Vascular Surgery Department, Ludwig Maximilian University Hospital, Munich, Germany
| | - Carlota F. Prendes
- Vascular Surgery Department, Ludwig Maximilian University Hospital, Munich, Germany
| | | | - Barbara Rantner
- Vascular Surgery Department, Ludwig Maximilian University Hospital, Munich, Germany
| | | | - Nikolaos Tsilimparis
- Vascular Surgery Department, Ludwig Maximilian University Hospital, Munich, Germany
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Thoracic Endovascular Aortic Repair for Aortobronchial Fistula 18 Years after Graft Replacement of the Descending Aorta. REPORTS 2022. [DOI: 10.3390/reports5030034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 77-year-old woman who had undergone graft replacement of the descending aorta 18 years prior presented to our hospital complaining of a cough with bloody sputum. She was diagnosed with aortobronchial fistula by computed tomography. Thoracic endovascular aortic repair was performed, and the patient was discharged from the hospital without any major complications. Postoperatively, bloody sputum disappeared, and computed tomography examination at 12 months postoperatively showed that the preoperative infiltrative shadows in the lung fields were reduced. In conclusion, thoracic endovascular aortic repair is an effective treatment for aortobronchial fistula.
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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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6
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Lee SG, Lee SH, Park WK, Kim DH, Song JW, Cho SH. Recurrent Aortobronchial Fistula after Endovascular Stenting for Infected Pseudoaneurysm of the Proximal Descending Thoracic Aorta: Case Report. J Chest Surg 2021; 54:425-428. [PMID: 33767025 PMCID: PMC8548198 DOI: 10.5090/jcs.20.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/02/2020] [Accepted: 11/12/2020] [Indexed: 12/05/2022] Open
Abstract
Aortobronchial fistula (ABF) induced by an infected pseudoaneurysm of the thoracic aorta is a life-threatening condition. As surgical treatment is associated with significant mortality and morbidity, thoracic endovascular aneurysm repair (TEVAR) may be an alternative for the treatment of ABF. However, the long-term durability of this intervention is largely unknown and the recurrence of ABF is a potential complication. We experienced a case of recurrent ABF after stent grafting as an early procedure for an infected pseudoaneurysm of the thoracic aorta. Remnant ABF, bronchial and/or aortic wall erosion, vasa vasorum connected with ABF, and recurrent local inflammation of the thin aortic wall around ABF might cause recurrent hemoptysis. As a result, we suggest that TEVAR should be considered as a bridge therapy for the initial treatment of ABF resulting from an infected pseudoaneurysm, and that several options, such as second-stage surgery, should be considered to prevent the recurrence of ABF.
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Affiliation(s)
- Sun-Geun Lee
- Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Seung Hyong Lee
- Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Won Kyoun Park
- Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Dae Hyun Kim
- Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Won Song
- Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sang-Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
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Kreibich M, Siepe M, Berger T, Pingpoh C, Puiu P, Morlock J, Walter T, Kondov S, Beyersdorf F, Rylski B, Czerny M. Treatment of infectious aortic disease with bovine pericardial tube grafts. Eur J Cardiothorac Surg 2021; 60:155-161. [PMID: 33523214 DOI: 10.1093/ejcts/ezab003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/20/2020] [Accepted: 12/08/2020] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES Our aim was to evaluate the mid-term outcomes of bovine pericardial tube graft repair for infectious aortic disease in any aortic segment. METHODS Between May 2015 and July 2020, 45 patients were treated for infectious aortic disease of the native (n = 9) aorta or after (endo-)graft (n = 36) implantation with bovine pericardial tube grafts. Clinical, infectious details, outcomes and follow-up data were evaluated. RESULTS All aortic segments underwent pericardial tube graft or bifurcational replacement: the aortic root (n = 12, 27%), ascending aorta (n = 18, 40%), aortic arch (n = 7, 16%), descending aorta (n = 5, 11%), thoraco-abdominal aorta (n = 6, 13%) and abdominal aorta (n = 18, 40%) including the iliac arteries (n = 14, 31%). Organ fistulation (n = 15, 33%) was the most common underlying pathology. Seven patients (16%) expired in-hospital secondary to ongoing sepsis (n = 5, 11%), respiratory failure (n = 1, 2%) and unknown cause (n = 1, 2%). A fungal infection was predictive for in-hospital mortality (P = 0.026, odds ratio: 19.470). After a median follow-up of 11 [first quartile: 2, third quartile 26] months, 9 additional patients (20%) expired and 1 patient developed a postoperative spondylodiscitis at the level of the aortic tube graft. Hence, freedom from proven aortic graft re-infection was 98%. CONCLUSIONS Orthotopic aortic reconstruction using bovine pericardial tube grafts to treat infectious aortic disease is possible in any aortic segment. Organ fistulation is a frequently observed disease mechanism requiring concomitant treatment. Granted, the early attrition rate is substantial, but after the initial period, both survival and freedom from re-infection appear encouraging.
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Affiliation(s)
- Maximilian Kreibich
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tim Berger
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Clarence Pingpoh
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Paul Puiu
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julia Morlock
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tim Walter
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stoyan Kondov
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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8
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Chien YS, Chao YC, Lee KS, Hsu KH. Aortotracheal fistula after slide tracheoplasty in a patient with dextrocardia, left pulmonary artery sling and tracheal stenosis: a case report. J Cardiothorac Surg 2021; 16:62. [PMID: 33789718 PMCID: PMC8011094 DOI: 10.1186/s13019-021-01438-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 03/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Aortotracheal fistula (ATF) is an uncommon and fatal complication of tracheal or aortic surgery, especially among pediatric patients. Case presentation We reported a case in a 1-year-old boy with dextrocardia, left pulmonary artery sling and long segment tracheal stenosis. He received slide tracheoplasty at 9 months of age and had post-operative refractory granulation at distal trachea status post repeated balloon dilatation and laser vaporization. Episodes of hemoptysis occurred on post-operative day 81. Bronchoscopy revealed a pulsating pseudoaneurysm at lower trachea which ruptured during the procedure Urgent surgical repair under cardiopulmonary bypass with deep hypothermic circulatory arrest was done. No recurrent bleeding or significant neurologic deficits noticed at a 4-month follow-up. Conclusion Congenital anomaly that changes the spatial relationship between trachea and aorta could have contributed to formation of ATF. This warrant future attention when managing tracheal granulation with this not uncommon anatomy. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01438-6.
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Affiliation(s)
- Yu-San Chien
- Department of Critical Care Mackay Memorial Hospital, CVICU-B, 7F, No. 92, Sec. 2, Zhongshan N. Rd, Taipei City, Taiwan
| | - Yen-Chun Chao
- Department of Pediatric Cardiology Mackay Children's Hospital, PICU, 11F, No. 92, Sec. 2, Zhongshan N. Rd, Taipei City, Taiwan
| | - Kuo-Sheng Lee
- Department of Otorhinolaryngology and Head & Neck Surgery Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd, Taipei City, Taiwan
| | - Kang-Hong Hsu
- Department of Cardiovascular Surgery Mackay Memorial Hospital, CVICU-B, 7F, No. 92, Sec. 2, Zhongshan N. Rd, Taipei City, Taiwan.
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9
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Upchurch GR, Escobar GA, Azizzadeh A, Beck AW, Conrad MF, Matsumura JS, Murad MH, Perry RJ, Singh MJ, Veeraswamy RK, Wang GJ. Society for Vascular Surgery clinical practice guidelines of thoracic endovascular aortic repair for descending thoracic aortic aneurysms. J Vasc Surg 2021; 73:55S-83S. [DOI: 10.1016/j.jvs.2020.05.076] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 12/17/2022]
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10
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Chakfé N, Diener H, Lejay A, Assadian O, Berard X, Caillon J, Fourneau I, Glaudemans AWJM, Koncar I, Lindholt J, Melissano G, Saleem BR, Senneville E, Slart RHJA, Szeberin Z, Venermo M, Vermassen F, Wyss TR, de Borst GJ, Bastos Gonçalves F, Kakkos SK, Kolh P, Tulamo R, Vega de Ceniga M, von Allmen RS, van den Berg JC, Debus ES, Koelemay MJW, Linares-Palomino JP, Moneta GL, Ricco JB, Wanhainen A. Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections. Eur J Vasc Endovasc Surg 2020; 59:339-384. [PMID: 32035742 DOI: 10.1016/j.ejvs.2019.10.016] [Citation(s) in RCA: 283] [Impact Index Per Article: 70.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Abstract
Aortobronchial fistulas (ABFs) are rare but fatal if left untreated. Hemoptysis is the most common symptom of the patients. ABFs may occur after any thoracic aortic lesions or maneuveurs for these lesions. The treatment of ABF can be surgical or thoracic endovascular aortic repair. Thoracic endovascular aortic repair can be a safe and less invasive procedure for the treatment of ABFs. However, ABFs might occur in much shorter time after thoracic endovascular aortic repair than any other etiologies. The prognoses of patients with ABFs are poor with a high morbidity and mortality. The selection of a suitable endovascular graft and avoidance of postinterventional complications might effectively prevent the occurrence of ABFs.
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Affiliation(s)
- Shi-Min Yuan
- Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, 389 Longdejing Street, Chengxiang District, Putian, 351100, Fujian Province, People's Republic of China.
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12
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Doctorian T, Narasimha D, Sakr A, Stoletniy L. Aortobronchial Fistula Causing Recurrent Hemoptysis 21 Years Post-Heart Transplant. Transplant Proc 2019; 51:3399-3402. [PMID: 31810508 DOI: 10.1016/j.transproceed.2019.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 08/30/2019] [Indexed: 11/17/2022]
Abstract
Aortobronchial fistulae (ABF) are uncommon but potentially fatal anomalies. Patients may initially present with small volume hemoptysis, which can rapidly lead to massive hemoptysis and death if not diagnosed and intervened upon early. Diagnosis by imaging and bronchoscopy is not always conclusive; thus, a high index of suspicion is necessary to diagnose this life-threatening condition. Herein, we describe a case of a young man who had a late presentation of ABF 21 years following heart transplantation. This case illustrates the diagnostic and clinical challenge of ABF as a late sequela of cardiac transplantation and highlights the rarity of this anomaly.
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Affiliation(s)
- Tanya Doctorian
- Divisions of Cardiology and Heart Transplant, Loma Linda University Medical Center, Loma Linda, CA.
| | - Deepika Narasimha
- Divisions of Cardiology and Heart Transplant, Loma Linda University Medical Center, Loma Linda, CA
| | - Antoine Sakr
- Divisions of Cardiology and Heart Transplant, Loma Linda University Medical Center, Loma Linda, CA
| | - Liset Stoletniy
- Divisions of Cardiology and Heart Transplant, Loma Linda University Medical Center, Loma Linda, CA
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13
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Endovascular Repair of Aortobronchial Fistula due to Saccular Aneurysm of Thoracic Aorta. Case Rep Vasc Med 2017; 2017:3158693. [PMID: 29279784 PMCID: PMC5723941 DOI: 10.1155/2017/3158693] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 11/09/2017] [Indexed: 12/01/2022] Open
Abstract
Aortobronchial fistula (ABF) is a rare condition which can be lethal if left untreated. Open surgical treatment carries high morbidity and mortality. Recent advances in endovascular technology have made thoracic endovascular aortic repair (TEVAR) the treatment of choice. We present a successful endovascular repair of aortobronchial fistula due to a saccular aneurysm of descending thoracic aorta.
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14
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Ujihira K, Kurimoto Y, Maruyama R, Iba Y, Nishioka N, Yamada A, Nakanishi K, Kato H, Abe M, Narita Y, Osawa M. Alternative Treatment for Residual Aortobronchial Fistula After Thoracic Endovascular Aortic Repair. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 11:453-456. [PMID: 27918318 DOI: 10.1097/imi.0000000000000327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A patient with an aortobronchial fistula secondary to a thoracic endovascular aortic repair was successfully treated with a re-thoracic endovascular aortic repair with debranching technique. Five months postoperatively, the aneurysm had shrunk; however, computed tomography revealed air in the thrombo-excluded aortic aneurysmal sac without signs of infection. Because of worsening air finding at the eighth month, we performed a resection of the residual fistula and wrapped the stent graft in a pedicled muscle flap.
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Affiliation(s)
- Kosuke Ujihira
- From the Departments of *Cardiovascular Surgery, †Thoracic Surgery, and ‡Plastic and Reconstructive Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
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15
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Wilson WR, Bower TC, Creager MA, Amin-Hanjani S, O’Gara PT, Lockhart PB, Darouiche RO, Ramlawi B, Derdeyn CP, Bolger AF, Levison ME, Taubert KA, Baltimore RS, Baddour LM. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association. Circulation 2016; 134:e412-e460. [DOI: 10.1161/cir.0000000000000457] [Citation(s) in RCA: 215] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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16
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Ujihira K, Kurimoto Y, Maruyama R, Iba Y, Nishioka N, Yamada A, Nakanishi K, Kato H, Abe M, Narita Y, Osawa M. Alternative Treatment for Residual Aortobronchial Fistula after Thoracic Endovascular Aortic Repair. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kosuke Ujihira
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Yoshihiko Kurimoto
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Ryushi Maruyama
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Yutaka Iba
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Naritomo Nishioka
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Akira Yamada
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Katsuhiko Nakanishi
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Hiroaki Kato
- Department of Thoracic Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Masaru Abe
- Department of Thoracic Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Yoshiaki Narita
- Department of Thoracic Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Masayuki Osawa
- Department of Plastic and Reconstructive Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
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17
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Giglio P, Patel VI. Successful management of infected thoracoabdominal graft and aortobronchial fistula using a hybrid approach. J Vasc Surg Cases 2015; 1:239-241. [PMID: 31724610 PMCID: PMC6849963 DOI: 10.1016/j.jvsc.2015.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 07/13/2015] [Indexed: 11/21/2022] Open
Abstract
We present the case of a 72-year-old patient who underwent successful management of a thoracoabdominal aortic graft infection. The patient was diagnosed with infected distal anastomotic pseudoaneurysm and aortobronchial fistula after type I thoracoabdominal aortic aneurysm repair. The infection was caused by the enteric gram-negative bacterium Proteus mirabilis. The high-risk patient was successfully treated with visceral debranching, infrarenal aortic reconstruction, and stent graft coverage of the pseudoaneurysm. The success of this case suggests that endovascular treatment of thoracoabdominal aortic graft infections may be a viable option in some high-risk patients.
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Affiliation(s)
| | - Virendra I. Patel
- Correspondence: Virendra I. Patel, MD, MPH, Massachusetts General Hospital, 15 Parkman St, Wang ACC 440, Boston, MA 02114
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18
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Kansal V, Nagpal S. Delayed diagnosis of hemoptysis in the case of prior aortic coarctation repair: A case report of aortobronchial fistula. Respir Med Case Rep 2015; 16:51-3. [PMID: 26744654 PMCID: PMC4681956 DOI: 10.1016/j.rmcr.2015.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 07/13/2015] [Indexed: 11/24/2022] Open
Abstract
We report a case of a 46-year old man who presented with spontaneous bright red blood per mouth for several months. The patient had history of aortic coarctation repair at age 17. Endoscopy and nasopharyngeoscopy revealed no source of bleeding. Computed tomography scan revealed the presence of thoracic aortic pseudoaneurysm with the formation of an aortobronchial fistula (ABF). This case illustrates the high index of suspicion for ABF in the case of hemoptysis or hematemesis with prior history of coarctation repair. Furthermore, we discuss the role of thoracic endovascular aneurysm repair (TEVAR) as the standard of repair over open surgery.
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Affiliation(s)
- Vinay Kansal
- University of Ottawa, Faculty of Medicine, Canada
| | - Sudhir Nagpal
- University of Ottawa, Division of Vascular Surgery, Canada; Ottawa Hospital Research Institute, Canada
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19
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Rifampin Soaking Dacron-Based Endografts for Implantation in Infected Aortic Aneurysms—New Application of a Time-Tested Principle. Ann Vasc Surg 2014; 28:744-8. [DOI: 10.1016/j.avsg.2013.10.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 10/01/2013] [Accepted: 10/12/2013] [Indexed: 11/23/2022]
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20
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Brown HA, Aruny JE, Elefteriades JA, Sumpio BE. Subclavian aneurysm presenting with massive hemoptysis: a case report and review of the literature. Int J Angiol 2014; 22:69-74. [PMID: 24436588 DOI: 10.1055/s-0033-1333862] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
We present a case of a 70-year-old male with a past medical history of coronary artery bypass grafting and end stage renal disease who presented with massive hemoptysis. He had a history of methicillin-resistant Staphylococcus aureus endocarditis, with infection and removal of endocardial pacing leads. His work-up revealed a 2.9-cm proximal left subclavian artery aneurysm. Bronchoscopy confirmed bright red blood in the left upper lobe bronchus and coronary angiography confirmed a patent left internal mammary artery (LIMA) to left anterior descending bypass. Because of the consideration of maintaining coronary perfusion via the LIMA while excluding the subclavian aneurysm, he underwent a left carotid to left axillary artery bypass graft followed by deployment of an Amplatzer II vascular plug just distal to the aneurysm. A thoracic endograft was then deployed to exclude the origin of the subclavian. A review of the literature reveals hemoptysis as a rare presentation of a subclavian aneurysm. We discuss approaches to this challenging clinical problem, ranging from open repair to hybrid approaches.
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Affiliation(s)
- Hilary A Brown
- Department of Vascular Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - John E Aruny
- Department of Interventional Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - John A Elefteriades
- Department of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Bauer E Sumpio
- Department of Vascular Surgery, Yale University School of Medicine, New Haven, Connecticut
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21
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Roselli EE, Abdel-Halim M, Johnston DR, Soltesz EG, Greenberg RK, Svensson LG, Sabik JF. Open aortic repair after prior thoracic endovascular aortic repair. Ann Thorac Surg 2014; 97:750-6. [PMID: 24411576 DOI: 10.1016/j.athoracsur.2013.10.033] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 10/05/2013] [Accepted: 10/11/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Thoracic endovascular aortic repair (TEVAR) has been applied to increasingly complex aortic pathology, resulting in an increase in late complications. We characterized patients undergoing open repair after prior TEVAR including indications, operative techniques, and outcomes. METHODS Chart review and query of a prospectively collected database identified 50 patients who underwent thoracic aortic operation after prior TEVAR. Active follow-up was supplemented by Social Security information for vital status. RESULTS From July 2001 to January 2012 open arch (n = 25), descending (n = 6), thoracoabdominal (n = 17), or extra-anatomic bypass (n = 2) operations were performed after previous TEVAR (median interval from TEVAR to open surgical procedure: 13.9 months; interquartile range, 0.5 to 24 months). Indications for open operation included type 1 endoleaks (n = 19), retrograde aortic dissection (n = 9), chronic aortic dissection with persistent growth of the false lumen (n = 16), and graft infection (n = 6). Sixty percent had prior cardiovascular surgical procedures and 18% were done as emergencies. Circulatory support was required in 78% and hypothermic arrest in 48%. Hospital mortality occurred in 3 (6%) patients with no strokes and 1 patient with myocardial infarction; 5 (10%) patients required tracheostomy and 1 required dialysis. Survival was 67% at a median follow-up of 2.9 years. CONCLUSIONS Conversion to open repair after thoracic stent-grafting may be indicated for type 1 endoleak, retrograde dissection, chronic aortic dissection with persistent false lumen growth, or graft infection. These salvage operations are complex but can be completed safely with good early outcomes and preservation of the stent-graft in most cases. Late outcomes are consistent with the chronic disease state of these patients.
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Affiliation(s)
- Eric E Roselli
- Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio.
| | | | | | | | - Roy K Greenberg
- Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio
| | - Lars G Svensson
- Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio
| | - Joseph F Sabik
- Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio
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22
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Ip EWK, Bourke VC, Stacey MC, Begley P, Ritter JC. Hard to diagnose and potentially fatal: slow aortic erosion post spinal fusion. J Emerg Med 2013; 46:335-40. [PMID: 24268895 DOI: 10.1016/j.jemermed.2013.08.075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 07/15/2013] [Accepted: 08/15/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Delayed aortic injuries are a rare, but well-recognized complication of spinal surgery. They are a result of slow erosion of osteosynthesis material into the aorta. Although this is a life-threatening complication, patients might present years later with nonspecific symptoms. OBJECTIVE A complex case of slow aortic injury after thoracic spinal surgery is presented, which highlights the challenges involved in diagnosis and treatment. CASE REPORT A 62-year-old man had a T6 vertebrectomy and T5-7 anterior spinal fusion for multiple myeloma 5 years earlier. Two years postoperatively, the patient developed intermittent hemoptysis that triggered several presentations to the emergency department and consecutive hospital admissions during a 3-year period. All investigations, including endoscopy, bronchoscopy, and repeated chest computed tomography (CT) scans, were unremarkable. Eventually, the patient presented with frank hemoptysis associated with severe left-sided chest pain. Urgent CT angiography revealed a pseudoaneurysm measuring 34 × 20 mm at the level of the vertebrectomy. The patient underwent emergency surgery and an endoluminal stent graft was successfully placed. The patient remains well after 6 months. CONCLUSIONS The close proximity of the aorta and spine entertains the risk of aortic injury associated with vertebral osteosynthesis. Long-term complications of slow aortic erosion are extremely difficult to diagnose. The presented patient suffered from an undetected bronchio-aortic fistula with consecutive pseudoaneurysm formation and rupture. Awareness of slow aortic erosion is important for correct diagnostic pathways and subsequent early diagnosis to ensure a positive outcome for the patient.
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Affiliation(s)
- Edmond W K Ip
- Department of Vascular and Endovascular Surgery, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Victor C Bourke
- Department of Vascular and Endovascular Surgery, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Michael C Stacey
- Department of Vascular and Endovascular Surgery, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Patrick Begley
- Emergency Department, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Jens C Ritter
- Department of Vascular and Endovascular Surgery, Fremantle Hospital, Fremantle, Western Australia, Australia
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23
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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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24
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Touma Y, Demondion P, Rama A, Leprince P. Aortobronchial fistula in the presence of a midgraft hole after endovascular repair of thoracic aortic aneurysms. Eur J Cardiothorac Surg 2012; 43:1259-61. [PMID: 23264588 DOI: 10.1093/ejcts/ezs653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Aortobronchial fistulas (ABF) are infrequent and require urgent diagnosis, often relying on a bundle of arguments. Thoracic endovascular aortic repair (TEVAR) is a possible therapeutic approach that needs close surveillance because its durability in such situations remains uncertain. We report a case of haemoptysis related to an aortobronchial fistula recurring 6 years after TEVAR, with an intraoperative finding of a midgraft hole. The patient underwent open repair with in situ aortic replacement with an aortic cryopreserved homograft.
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Affiliation(s)
- Youssef Touma
- Department of Cardio-Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Pierre et Marie Curie University, Paris, France.
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25
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Nguyen T, Peters P, McGahan T, Shah P. Staged management of a primary aortobronchial fistula: a novel approach using a trapezius flap repair. Heart Lung Circ 2012; 21:292-4. [PMID: 22464594 DOI: 10.1016/j.hlc.2012.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 11/06/2011] [Accepted: 01/17/2012] [Indexed: 11/17/2022]
Abstract
There have been few reported cases of management of an aortobronchial fistula. We describe the case of a 68 year-old male with a very high operative risk who had a successful staged management of a primary aortobronchial fistula. An endovascular stent was placed initially, however due to recurrence of the fistula a second stent was deployed within the first one some three months after. Fifteen months later he represented with massive haemoptysis, severe cachexia and at this stage the best course of surgical management was thought to be lobectomy via thoracotomy followed by trapezius flap overlay covering the exposed stent and separating it from the remaining lung.
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Affiliation(s)
- Tam Nguyen
- Department of Cardiothoracic Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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27
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Surgical conversion after thoracic endovascular aortic repair. J Thorac Cardiovasc Surg 2011; 142:1027-31. [DOI: 10.1016/j.jtcvs.2011.01.060] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Revised: 01/06/2011] [Accepted: 01/25/2011] [Indexed: 12/23/2022]
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28
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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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29
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Leach SB, Fine DM, Schutrumpf RJ, Britt LG, Edward Durham H, Christiansen K. Coil embolization of an aorticopulmonary fistula in a dog. J Vet Cardiol 2010; 12:211-6. [DOI: 10.1016/j.jvc.2010.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 06/24/2010] [Accepted: 06/28/2010] [Indexed: 10/18/2022]
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30
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Thoracic aortic endovascular repair for mycotic aneurysms and fistulas. J Vasc Surg 2010; 52:37S-40S. [DOI: 10.1016/j.jvs.2010.06.139] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 06/15/2010] [Accepted: 06/17/2010] [Indexed: 11/18/2022]
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31
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Hemoptisis recurrente debido a un aneurisma de la arteria subclavia izquierda. ANGIOLOGIA 2010. [DOI: 10.1016/s0003-3170(10)70021-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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