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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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2
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Kahlberg A, Grandi A, Loschi D, Vermassen F, Moreels N, Chakfé N, Melissano G, Chiesa R. A systematic review of infected descending thoracic aortic grafts and endografts. J Vasc Surg 2019; 69:1941-1951.e1. [PMID: 30606664 DOI: 10.1016/j.jvs.2018.10.108] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 10/26/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The objective of this study was to collect and critically analyze the current evidence on the modalities and results of treatment of descending thoracic aortic surgical graft (SG) and endograft (EG) infection, which represents a rare but dramatic complication after both surgical and endovascular aortic repair. METHODS A comprehensive electronic health database search (PubMed/MEDLINE, Scopus, Google Scholar, and the Cochrane Library) identified all articles that were published up to October 2017 reporting on thoracic aortic SG or EG infection. Observational studies, multicenter reports, single-center series and case reports, case-control studies, and guidelines were considered eligible if reporting specific results of treatment of descending thoracic aortic SG or EG infection. Comparisons of patients presenting with SG or EG infection and between invasive and conservative treatment were performed. Odds ratio (OR) meta-analyses were run when comparative data were available. RESULTS Forty-three studies reporting on 233 patients with infected SG (49) or EG (184) were included. Four were multicenter studies including 107 patients, all with EG infection, associated with a fistula in 91% of cases, with a reported overall survival at 2 years of 16% to 39%. The remaining 39 single-center studies included 49 patients with SG infection and 77 with EG infection. Association with aortoesophageal fistula was significantly more common with EG (60% vs 31%; P = .01). In addition, time interval from index procedure to infection was significantly shorter with EG (17 ± 21 months vs 32 ± 61 months; P = .03). Meta-analysis showed a trend of increased 1-year mortality in patients with SG infection compared with EG infection (pooled OR, 3.6; 95% confidence interval, 0.9-14.7; P = .073). Surgical management with infected graft explantation was associated with a trend toward lower 1-year mortality compared with graft preservation (pooled OR, 0.3; 95% confidence interval, 0.1-1.0; P = .056). CONCLUSIONS Thoracic aortic EG infection is likely to occur more frequently in association with aortoesophageal fistulas and in a shorter time compared with SG infection. Survival is poor in both groups, especially in patients with SG infection. Surgical treatment with graft explantation seems to be the preferable choice in fit patients.
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Affiliation(s)
- Andrea Kahlberg
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milan, Italy.
| | - Alessandro Grandi
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Diletta Loschi
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Frank Vermassen
- Department of Vascular and Thoracic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Nathalie Moreels
- Department of Vascular and Thoracic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Nabil Chakfé
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Germano Melissano
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Chiesa
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milan, Italy
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3
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Kahlberg A, Melissano G, Mascia D, Loschi D, Grandi A, Chiesa R. How to best treat infectious complications of open and endovascular thoracic aortic repairs. Semin Vasc Surg 2017; 30:95-102. [PMID: 29248127 DOI: 10.1053/j.semvascsurg.2017.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Infectious complications of open and endovascular procedures for descending thoracic aortic disease are relatively rare, affecting 1% to 6% of treated patients. However, the number of thoracic aortic procedures, especially endovascular, is increasing continuously, and infectious complications involving the graft or endograft have been observed more frequently in recent years. Several causative factors may play a role in thoracic aortic prosthetic infections, including hematogenous seeding, local bacterial translocation, and iatrogenous contamination. In addition, the development of a fistula between the aortic graft and the esophagus or the bronchial tree is a common associated finding, representing a dramatic event that further increases mortality rates and requires multidisciplinary management. Treatment of these conditions is demanding, often including a number of pharmacological, surgical, and endovascular options. Because there are several different surgical strategies and timing modalities that are chosen according to the surgeon's experience, the results of different treatment options are difficult to summarize, and no consensus exists on a standardized paradigm of treatment. In this review, published reports regarding clinical outcomes related to thoracic graft and endograft infections are discussed, including our personal experience with surgical and endovascular management of this condition.
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Affiliation(s)
- Andrea Kahlberg
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy.
| | - Germano Melissano
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy
| | - Daniele Mascia
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy
| | - Diletta Loschi
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy
| | - Alessandro Grandi
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy
| | - Roberto Chiesa
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy
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4
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Böckler D, Schumacher H, Schwarzbach M, Ockert S, Rotert H, Allenberg JR. Endoluminal Stent-Graft Repair of Aortobronchial Fistulas: Bridging or Definitive Long-Term Solution? J Endovasc Ther 2016; 11:41-8. [PMID: 14748630 DOI: 10.1177/152660280401100105] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To describe our experience with endoluminal stent-graft repair of aortobronchial fistulas (ABF) and to analyze midterm results focusing on late chronic graft infections, secondary conversion, and survival. Methods: The records of 8 patients (6 men; mean age 69 years, range 28–88) treated between March 1997 and October 2003 for traumatic and postsurgical ABFs were reviewed. Seven presented with hemoptysis and 1 with hemorrhagic shock. According to the severity of emergency, patients underwent computed tomography, angiography, bronchoscopy, and transesophageal echocardiography. Preoperatively, no clinical signs of infection were evident. Two different stent-graft models (Talent and Excluder) were implanted using standard endovascular techniques. Results: Procedural and clinical success was achieved in all patients. Paraplegia, secondary intervention, conversion, or procedure-related death was not observed. Mean follow-up was 30 months (range 0.6–77). One patient with a postsurgical ABF (Dacron tube graft) successfully treated with an Excluder stent-graft died 13 months later from hemorrhage secondary to aortoesophageal fistula repair procedures. A second patient died from pneumonia after 42 months. A third patient, in whom 2 Talent stent-grafts had been implanted to treat an ABF from the false lumen of a type B dissection, died 7 months later from massive hemorrhage. Conclusions: Endoluminal stent-grafting of ABF is feasible and the preferred method of treatment. Secondary conversion due to endograft infection is not absolutely mandatory, but close surveillance is necessary.
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Affiliation(s)
- Dittmar Böckler
- Department of Vascular and Endovascular Surgery, Ruprecht-Karls University Heidelberg, Germany.
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5
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Tognarelli A, Palmieri C, Rizza A, Troiani R, Vaghetti M, Mariani M, Murzi M, Trianni G, Berti S, de Donato G, Setacci F, Galzerano G, Setacci C, Stabile E, Esposito G. How should I treat a massive pulmonary haemorrhage secondary to a TEVAR procedure in a patient with a thoracic aortic aneurysm and a type B aortic dissection? EUROINTERVENTION 2015; 11:963-6. [PMID: 26696459 DOI: 10.4244/eijv11i8a196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Andrea Tognarelli
- Adult Cardiology Unit, Fondazione Toscana Gabriele Monasterio, Ospedale del Cuore, Massa, Tuscany, Italy
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Moulakakis KG, Mylonas SN, Antonopoulos CN, Kakisis JD, Sfyroeras GS, Mantas G, Liapis CD. Comparison of treatment strategies for thoracic endograft infection. J Vasc Surg 2014; 60:1061-71. [DOI: 10.1016/j.jvs.2014.07.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 07/16/2014] [Indexed: 12/17/2022]
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7
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Multidetector CT findings of complications of surgical and endovascular treatment of aortic aneurysms. Radiol Clin North Am 2014; 52:961-89. [PMID: 25173654 DOI: 10.1016/j.rcl.2014.05.002] [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: 11/21/2022]
Abstract
Aortic aneurysms remain a significant problem in the population, and there is a concerted effort to identify, define, image, and treat these conditions to ultimately improve outcomes. The rapid development of diagnostic modalities, operative strategies, and endovascular techniques within the realm of this aortic disease has transformed the field and broadened the spectrum of patients that can be treated with minimally invasive techniques. This investigation has a broad spectrum of normal expected findings that must be differentiated from early or late complications in which intervention is required. In this article, normal and abnormal postoperative and post-TEVAR/EVAR MDCT findings are described.
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8
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Valente T, Rossi G, Lassandro F, Rea G, Marino M, Dialetto G, Muto R, Scaglione M. Unusual complications of endovascular repair of the thoracic aorta: MDCT findings. Radiol Med 2012; 117:831-54. [PMID: 22228128 DOI: 10.1007/s11547-011-0771-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 06/20/2011] [Indexed: 11/26/2022]
Abstract
With the development of minimally invasive surgical techniques, endovascular stent-graft placement has become an accepted and widely used alternative to the traditional surgical repair of aortic disease and is gaining acceptance as the treatment of choice. Many studies show that endovascular stent-graft therapy is safe and effective, although complications related to this treatment are also recognised. Although the incidence of major complication is low, neurological sequelae remain the major concern of endovascular repair. With growing experience, however, the spectrum of mid- and long-term complications has broadened to include potentially disastrous events, other than paraplegia or stroke, that require diligent surveillance. Three-dimensional data sets acquired quickly by multidetector computed tomography (MDCT) allow multiplanar reformations and 3D viewing, as well as quantitative assessment of vessel lumens, walls and surroundings. Although a large portion of radiologists will not be involved in the actual endograft deployment, many will be involved in the interpretation of postprocedural surveillance studies. Accordingly, the goal of this report is to summarise our experience with the presentation, diagnostic approach, management and outcomes of these unusual, but potentially catastrophic, postendovascular aortic repair complications to highlight their significance and increase familiarity with them among the imaging community. Increasing awareness of these complications may facilitate rapid diagnosis and/or triage and treatment.
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Affiliation(s)
- T Valente
- Dipartimento di Diagnostica per Immagini, Servizio di Radiologia, A.O.R.N. Monaldi, 80131, Napoli, Italy
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9
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Li HP, Hsieh CC, Chiang HH, Wang TH, Lee JY, Huang MF, Chou SH. Aortobronchial fistula after esophagectomy for esophageal cancer -- a very rare complication. Kaohsiung J Med Sci 2011; 27:247-50. [PMID: 21601172 DOI: 10.1016/j.kjms.2010.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 09/16/2010] [Indexed: 12/29/2022] Open
Abstract
Most aorto-respiratory fistulas are related to aortic pathology or procedures, but fistula formation after esophageal resection has never been reported in the literature. We are now reporting a case of hemoptysis that occurred after esophagectomy for locally advanced esophageal cancer. Aortobronchial fistula was detected by computed tomography scan. The patient was finally saved by emergency surgery-Dacron graft interposition of the descending thoracic aorta. There was no malignant cell in the postoperative specimen of the fistula. The erosion of the ligaclips (Johnson & Johnson) might be responsible for the aortobronchial fistula formation. For esophageal surgery, avoidance of trauma to aortic wall and careful using of ligaclips are important to circumvent this complication.
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Affiliation(s)
- Hsien-Pin Li
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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10
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Chiesa R, Melissano G, Marone EM, Marrocco-Trischitta MM, Kahlberg A. Aorto-oesophageal and aortobronchial fistulae following thoracic endovascular aortic repair: a national survey. Eur J Vasc Endovasc Surg 2010; 39:273-9. [PMID: 20096612 DOI: 10.1016/j.ejvs.2009.12.007] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2009] [Accepted: 12/07/2009] [Indexed: 12/20/2022]
Abstract
OBJECTIVE We evaluated the incidence of aorto-oesophageal (AEF) and aortobronchial (ABF) fistulae after thoracic endovascular aortic repair (TEVAR), and investigated their clinical features, determinants, therapeutic options and results. METHODS We conducted a voluntary national survey among Italian universities and hospital centres with a thoracic endovascular programme. RESULTS Thirty-nine centres were contacted, and 17 participated. Of the patients who underwent TEVAR between 1998 and 2008, 19/1113 (1.7%) developed AEF/ABF. Among indications to TEVAR, aortic pseudo-aneurysm was associated with the development of late AEF/ABF (P = 0.009). Further, emergent and complicated procedures resulted in increased risk of AEF/ABF (P = 0.008 and P < 0.001, respectively). Eight patients were treated conservatively, all of whom died within 30 days. Eleven patients underwent AEF/ABF surgical treatment, with a perioperative mortality of 64% (7/11). At a mean follow-up of 17.7 +/- 12.5 months, overall survival was 16% (3/19). CONCLUSIONS The incidence of AEF and ABF following TEVAR is not negligible, and is comparable to that following open repair. This finding warrants an ad hoc long-term follow-up after TEVAR, particularly in patients submitted to emergent and complicated procedures. Both surgical and endovascular treatment of AEF/ABF are associated with high mortality. However, conservative treatment does not appear to be a viable option.
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Affiliation(s)
- R Chiesa
- Vascular Surgery, Scientific Institute H. San Raffaele, Vita-Salute University School of Medicine, Via Olgettina 60, 20132 Milano, MI, Italy
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11
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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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12
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Kuizenga K, Reijnen MM, Tielliu IF, Verhoeven EL, van den Dungen JJ, Zeebregts CJ. Conventional or Endovascular Treatment of Ongoing Mycotic Aortic Aneurysmal Disease? Vascular 2009; 17:103-7. [DOI: 10.2310/6670.2008.00063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report a case in which conventional and endovascular exclusion techniques were used to treat ongoing mycotic aortic aneurysmal disease. A 51-year-old man presented with an infrarenal mycotic aortic aneurysm that was excluded and reconstructed with a superficial femoral vein. Two years later, he developed a symptomatic mycotic aneurysm of the descending thoracic aorta, which required emergent treatment with a stent graft. The patient died 5 months later of massive bleeding owing to an aortobronchial fistula deriving from a new thoracic aneurysm proximal to the stent graft. Choices and different modes of treatment are discussed. Endovascular treatment of symptomatic mycotic aortic aneurysm might provide a valid alternative to open repair but may be unsuccessful owing to ongoing infection. In situ replacement using autologous material seems appealing whenever feasible.
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Affiliation(s)
- Kirsten Kuizenga
- *Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, the Netherlands; and †Department of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem, the Netherlands
| | - Michel M.P.J. Reijnen
- *Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, the Netherlands; and †Department of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem, the Netherlands
| | - Ignace F.J. Tielliu
- *Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, the Netherlands; and †Department of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem, the Netherlands
| | - Eric L.G. Verhoeven
- *Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, the Netherlands; and †Department of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem, the Netherlands
| | - Jan J.A.M. van den Dungen
- *Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, the Netherlands; and †Department of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem, the Netherlands
| | - Clark J. Zeebregts
- *Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, the Netherlands; and †Department of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem, the Netherlands
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13
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Husari AW, Al-Kutoubi A, Matouk A, Khalil I, Haddad F. Pulmonary hemorrhage secondary to aortobronchial fistula occurring soon after the placement of an endovascular stent for a thoracic aortic aneurysm. J Vasc Interv Radiol 2007; 18:1601-2. [PMID: 18057300 DOI: 10.1016/j.jvir.2007.08.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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14
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Pitton MB, Herber S, Schmiedt W, Neufang A, Dorweiler B, Düber C. Long-Term Follow-Up After Endovascular Treatment of Acute Aortic Emergencies. Cardiovasc Intervent Radiol 2007; 31:23-35. [PMID: 17943352 DOI: 10.1007/s00270-007-9175-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2007] [Revised: 07/12/2007] [Accepted: 08/29/2007] [Indexed: 11/30/2022]
Affiliation(s)
- M B Pitton
- Department of Diagnostic and Interventional Radiology, University Hospital of Mainz, Johannes Gutenberg University of Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
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15
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Böckler D, Schumacher H, Schwarzbach M, Ockert S, Rotert H, Allenberg JR. Endoluminal Stent-Graft Repair of Aortobronchial Fistulas:Bridging or Definitive Long-term Solution? J Endovasc Ther 2004. [DOI: 10.1583/1545-1550(2004)011<0041:esroaf>2.0.co;2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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16
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Lamme B, de Jonge ICDYM, Reekers JA, de Mol BAJM, Balm R. Endovascular treatment of thoracic aortic pathology: feasibility and mid-term results. Eur J Vasc Endovasc Surg 2003; 25:532-9. [PMID: 12787695 DOI: 10.1053/ejvs.2002.1852] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE to report our experience with 21 consecutive patients treated with a thoracic stent-graft. DESIGN retrospective analysis. MATERIALS AND METHODS Between October 1998 and February 2002, 21 patients (12 male), mean age 55.6 years (range 19-86 years), were treated for aorticortic pathology localized to the descending aorta (18 patients), the aortic arch (2 patients) and the ascending aorta (1 patient) and comprising true aneurysms (8 patients), false aneurysms (6 patients), traumatic rupture (4 patients), mycotic aneurysms (2 patients), and ruptured aneurysm (1 patient). Plain chest X-rays and computed tomography was performed at 3, 6 and 12 months postoperatively and then annually. RESULTS the median (range) operation time was 85min (50-305min), hospital stay 6 days (3-63 days) and follow-up 24 months (5-44 months). Complications occurred in 5 patients and comprised intraoperative migration (1), type I endoleak (1), type II endoleak (1), ischemic myelopathy (1), pneumonia (2), suture granuloma (1) and common femoral artery dissection (1). CONCLUSIONS stent-grafting can be successfully employed to treat a wide range of thoracic aortic pathologies with a mortality, morbidity and resource utilization that is considerably less than that associated with conventional surgery. However, long term follow-up on safety and efficacy is needed.
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Affiliation(s)
- B Lamme
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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17
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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. [PMID: 12822663 DOI: 10.1016/s0003-4975(02)04837-3] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Postoperative aortobronchial and aortopulmonary fistulas are rare and late complications of cardiac surgery. They mostly complicate descending thoracic aortic procedures. Hemoptysis is the main symptom, and may be massive or intermittent. The reported interval between the time of operation and the onset of hemoptysis ranges from 3 weeks to 25 years. Diagnostic examinations are often unable to directly visualize a fistula. Indication for surgical or endovascular repair mostly relies on clinical suspicion and nonspecific diagnostic features. Urgent treatment is based on the association of the following elements: (1) hemoptysis, (2) history of previous cardiac or aortic operation, (3) presence of lung infiltrates on the chest roentgenogram, (4) lung hemorrage on the computed tomographic scan, and (5) and visualization of a pseudoaneurysm. Aortobronchopulmonary fistulas are uniformly fatal if untreated. The overall surgical mortality rate is 15.3%. There is no procedure-related mortality after endovascular stent grafting. A review of the English-language literature from 1947 to October 2002 is presented.
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Affiliation(s)
- Marco Picichè
- Cardiac Surgery Department, San Bortolo Hospital, Vicenza, Italy
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18
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Léobon B, Roux D, Mugniot A, Rousseau H, Cérene A, Glock Y, Fournial G. Endovascular treatment of thoracic aortic fistulas. Ann Thorac Surg 2002; 74:247-9. [PMID: 12118773 DOI: 10.1016/s0003-4975(02)03466-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Aortoesophageal and aortobronchial fistulas constitute a problem in therapy because of the high rates of morbidity and mortality associated with operation. From May 1996 to March 2000, we treated by an endovascular procedure one aortoesophageal and three aortobronchial fistulas. There was no postoperative death. We noted one peripheral vascular complication that required a surgical procedure, one postoperative confusion, and one inflammatory syndrome. In one case, because of a persistent leakage after 21 months, we had to implant a second endovascular stent graft. A few weeks later the reopening of this patient's esophageal fistula led to his death by mediastinitis 25 months after the first procedure. The few cases published seem to bear out the interest, observed in our 4 patients, of an endovascular approach to treat complex lesions such as fistulas of the thoracic aorta especially in emergency or palliative cases.
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Affiliation(s)
- Bertrand Léobon
- Department of Cardiovascular Surgery A, Rangueil Hospital, Toulouse, France
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Nouraei SM, Pillay T, Hilton CJ. Emergency management of aorto-bronchial fistula after implantation of a self-expanding bronchial stent. Eur J Cardiothorac Surg 2001; 20:642-4. [PMID: 11509298 DOI: 10.1016/s1010-7940(01)00836-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We report a case of aorto-bronchial fistula 7 years after implantation of a self-expanding metal stent into the left main bronchus. The clinical presentation was characterised by left-sided chest pain, dyspnea and a single bout of haemoptysis. The fistula was surgically managed by aortic resection and primary repair of the aorta, and patch repair of the left main bronchus over a Polyflex covered bronchial stent. When haemoptysis occurs in a patient with a history of bronchial stent implantation, the presence of an aorto-bronchial fistula should be considered. Early diagnosis offers the only possibility of recovery through a lifesaving surgical procedure.
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Affiliation(s)
- S M Nouraei
- Regional Cardiothoracic Centre, Freeman Hospital, NE7 7DN, Newcastle upon Tyne, UK.
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Bromley PJ, Ochs OD, Slater M, Shen I, Keller FS. SCVIR annual meeting film panel session: diagnosis and discussion of case 6. J Vasc Interv Radiol 2001; 12:658-61. [PMID: 11340150 DOI: 10.1016/s1051-0443(07)61495-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- P J Bromley
- Dotter Interventional Institute, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, Oregon 97201-3098, USA
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Bromley PJ, Kaufman JA. Abdominal aortic aneurysms before and after endograft implantation: evaluation by computed tomography. Tech Vasc Interv Radiol 2001; 4:15-26. [PMID: 11981786 DOI: 10.1053/tvir.2001.23090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The evaluation of patients with abdominal aortic aneurysms for endograft candidacy and their follow-up after treatment are heavily dependent on radiologic imaging. Factors never considered during conventional open repair have become crucial to patient selection and procedural success, and the new and developing nature of the field of endovascular repair necessitates close surveillance of these devices after deployment. Computed tomography (CT) has emerged as the single most effective imaging tool for the preprocedural assessment and subsequent follow-up of these patients. This article outlines the technical parameters for obtaining pre- and postoperative CT examinations in endograft patients and discusses the important imaging findings.
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Affiliation(s)
- P J Bromley
- Dotter Interventional Institute, Oregon Health Sciences University, 3181 Sam Jackson Park Road, Portland, OR 97201-3098, USA
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