1
|
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: 0] [Impact Index Per Article: 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.
Collapse
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"
| |
Collapse
|
2
|
Izzo D, Savino K, Castellani C, Sperandini L, Ragni T, Ambrosio G, Cavallini C. Post-traumatic Aortopulmonary Fistula after Bentall Procedure. J Cardiovasc Echogr 2020; 30:29-32. [PMID: 32766103 PMCID: PMC7307618 DOI: 10.4103/jcecho.jcecho_5_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/25/2020] [Accepted: 03/09/2020] [Indexed: 11/29/2022] Open
Abstract
Pseudoaneurysm complicated by aortopulmonary fistula (APF) after a Bentall procedure is extremely rare but potentially fatal, so timely diagnosis and treatment are critical. We present a subacute case of a post-traumatic APF which has had initial aspecific symptoms and later an acute worsening heart failure with chest pain not responding to medical treatment and requiring emergency surgery.
Collapse
Affiliation(s)
- Daniela Izzo
- Department of Cardiology and Cardiovascular Physiopathology, University of Perugia, Perugia, Italy
| | - Ketty Savino
- Department of Cardiology and Cardiovascular Physiopathology, University of Perugia, Perugia, Italy
| | | | | | | | - Giuseppe Ambrosio
- Department of Cardiology and Cardiovascular Physiopathology, University of Perugia, Perugia, Italy
| | | |
Collapse
|
3
|
Fan X, He J, Peng J, Zhuang J. Reoperation for ascending aorta aneurysm after double valve replacement in a Takayasu's aortitis patient: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2017; 1:ytx015. [PMID: 31020073 PMCID: PMC6177096 DOI: 10.1093/ehjcr/ytx015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/02/2017] [Indexed: 11/28/2022]
Abstract
Takayasu’s aortitis (TA) is a complicated disease. Surgical treatment, especially reoperation, can be difficult. Here, we report a case of reoperation for TA, which presented with three major complications (aortic aneurysm, valve detachment, and fistula) 3 years after surgical treatment. During the surgery, the aortic valve was reconsolidated and fixed to the mitral valve, the fistula was then repaired, and the aortic root was replaced with woven graft. Following an uncomplicated postoperative event, the patient was discharged at 24 days postoperatively. Follow-up echocardiography at 2 years showed no perivalvular leakage. In such reoperative cases, when double valve replacement is required, it may be better to proactively reconstruct the structure of the central fibrous body.
Collapse
Affiliation(s)
- Xiaoping Fan
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106th Zhongshan Er Road, Yuexiu District, 510080 Guangzhou, China
| | - Jie He
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106th Zhongshan Er Road, Yuexiu District, 510080 Guangzhou, China
| | - Jihai Peng
- Department of Rehabilitation, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106th Zhongshan Er Road, Yuexiu District, 510080 Guangzhou, China
| | - Jian Zhuang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106th Zhongshan Er Road, Yuexiu District, 510080 Guangzhou, China
| |
Collapse
|
4
|
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.
Collapse
Affiliation(s)
- Dittmar Böckler
- Department of Vascular and Endovascular Surgery, Ruprecht-Karls University Heidelberg, Germany.
| | | | | | | | | | | |
Collapse
|
5
|
Biasi GM. Aortocaval Fistula: A Challenge for Endovascular Management. J Endovasc Ther 2016. [DOI: 10.1177/152660289900600416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Giorgio M. Biasi
- Department of Vascular Surgery, Bassini Teaching Hospital, University of Milan, Milan, Italy
| |
Collapse
|
6
|
Alameddine AK, Alimov VK. Endovascular Closure of an Aortic Pseudoaneurysm Complicated by Aorto‐Pulmonary Fistula. J Card Surg 2016; 31:453-5. [DOI: 10.1111/jocs.12758] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Abdallah K. Alameddine
- Division of Cardiac SurgeryBaystate Medical CenterSpringfieldMassachusetts
- Tufts School of MedicineBostonMassachusetts
| | - Victor K. Alimov
- Division of Cardiac SurgeryBaystate Medical CenterSpringfieldMassachusetts
- Tufts School of MedicineBostonMassachusetts
| |
Collapse
|
7
|
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]
|
8
|
Multiple endovascular stent-graft implantations in a patient with aortic thoracic and abdominal aneurysms due Takayasu arteritis. Rheumatol Int 2013; 34:723-5. [DOI: 10.1007/s00296-012-2598-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 12/05/2012] [Indexed: 10/27/2022]
|
9
|
|
10
|
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]
|
11
|
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]
|
12
|
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.
Collapse
Affiliation(s)
- Frederik H W Jonker
- Department of Surgery and Radiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | | | | | | | | | | |
Collapse
|
13
|
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]
|
14
|
Islam T, Hines G, Katz DS, Purtil W, Castiller F. Life-Threatening Upper Gastrointestinal Bleeding Secondary to Aortoenteric Fistula. CLINICAL MEDICINE. CIRCULATORY, RESPIRATORY AND PULMONARY MEDICINE 2008. [DOI: 10.4137/ccrpm.s376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We present a patient with gastrointestinal bleeding secondary to an aortoduodenal fistula. The patient had undergone an open surgical repair of an abdominal aortic aneurysm five years prior to admission.
Collapse
Affiliation(s)
- Tasbirul Islam
- Pulmonary and Critical Care Medicine, Winthrop-University Hospital, Mineola, NY, U.S.A
- Department of Vascular Surgery, Winthrop-University Hospital, Mineola, NY, U.S.A
- State University of New York at Stony Brook, Stony Brook, NY, U.S.A
- Department of Radiology, Winthrop-University Hospital, Mineola, NY, U.S.A
- Department of Vascular Surgery Winthrop-University Hospital, Mineola, NY, U.S.A
| | - George Hines
- Pulmonary and Critical Care Medicine, Winthrop-University Hospital, Mineola, NY, U.S.A
- Department of Vascular Surgery, Winthrop-University Hospital, Mineola, NY, U.S.A
- State University of New York at Stony Brook, Stony Brook, NY, U.S.A
- Department of Radiology, Winthrop-University Hospital, Mineola, NY, U.S.A
- Department of Vascular Surgery Winthrop-University Hospital, Mineola, NY, U.S.A
| | - Douglas S. Katz
- Pulmonary and Critical Care Medicine, Winthrop-University Hospital, Mineola, NY, U.S.A
- Department of Vascular Surgery, Winthrop-University Hospital, Mineola, NY, U.S.A
- State University of New York at Stony Brook, Stony Brook, NY, U.S.A
- Department of Radiology, Winthrop-University Hospital, Mineola, NY, U.S.A
- Department of Vascular Surgery Winthrop-University Hospital, Mineola, NY, U.S.A
| | - William Purtil
- Pulmonary and Critical Care Medicine, Winthrop-University Hospital, Mineola, NY, U.S.A
- Department of Vascular Surgery, Winthrop-University Hospital, Mineola, NY, U.S.A
- State University of New York at Stony Brook, Stony Brook, NY, U.S.A
- Department of Radiology, Winthrop-University Hospital, Mineola, NY, U.S.A
- Department of Vascular Surgery Winthrop-University Hospital, Mineola, NY, U.S.A
| | - Francis Castiller
- Pulmonary and Critical Care Medicine, Winthrop-University Hospital, Mineola, NY, U.S.A
- Department of Vascular Surgery, Winthrop-University Hospital, Mineola, NY, U.S.A
- State University of New York at Stony Brook, Stony Brook, NY, U.S.A
- Department of Radiology, Winthrop-University Hospital, Mineola, NY, U.S.A
- Department of Vascular Surgery Winthrop-University Hospital, Mineola, NY, U.S.A
| |
Collapse
|
15
|
Wheatley GH, Nunez A, Preventza O, Ramaiah VG, Rodriguez-Lopez JA, Williams J, Olsen D, Diethrich EB. Have we gone too far? Endovascular stent-graft repair of aortobronchial fistulas. J Thorac Cardiovasc Surg 2007; 133:1277-85. [PMID: 17467441 DOI: 10.1016/j.jtcvs.2006.11.066] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Revised: 10/27/2006] [Accepted: 11/06/2006] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Although endovascular repair of the descending thoracic aorta has emerged as a viable treatment option, little is known about its potential to treat patients diagnosed with aortobronchial fistulas. We reviewed our comprehensive thoracic endografting experience with regard to the endovascular management and subsequent outcome of patients with aortobronchial fistulas to assess whether endoluminal graft repair is a realistic option. METHODS Between February 2000 and November 2005, 255 patients were successfully treated with an endoluminal graft to the descending thoracic aorta. Indications for intervention included: atherosclerotic aneurysms (109/255, 42.7%), acute and chronic dissections (75/255, 29.4%), miscellaneous (34/255, 13.3%), penetrating aortic ulcers (30/255, 11.8%), and aortobronchial fistulas (7/255, 2.7%). RESULTS Average patient age was 73.4 +/- 10.1 years, with 4 male patients (4/7, 57.1%) and 3 female patients (3/7, 42.9%). All patients presented with hemoptysis, with 1 patient (1/7, 14.3%) requiring preoperative blood transfusion. Three patients (3/7, 42.9%) were diagnosed with atherosclerotic aneurysms, 3 patients (3/7, 42.9%) had pseudoaneurysms associated with prior open surgical repair, and 1 patient (1/7, 14.3%) had a prior endoluminal graft placed for a traumatic aortic transection. No standard postoperative antibiotic regimen was followed. There were no endoleaks, no incidences of paraplegia, and no endoluminal graft infections. Survival was 100% (7/7) at both 30 days and 1 year, and all patients are currently alive. Follow-up computed tomography was available for all 7 patients, with an average follow-up of 42.6 +/- 28.5 months. CONCLUSIONS Endovascular management of aortobronchial fistulas appears to be safe and well tolerated, even in surgically high-risk patients, with minimal risk of prosthesis infection. Long-term surveillance and continued investigation are warranted.
Collapse
Affiliation(s)
- Grayson H Wheatley
- Department of Cardiovascular and Endovascular Surgery, Arizona Heart Institute, Phoenix, Ariz 85006, USA.
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Ishibashi H, Ohta T, Sugimoto I, Kawanishi J, Yamada T, Ishiguchi T, Io A. Successful Treatment of an Aorto-Ileal-Conduit Fistula with an Endovascular Stent Graft: Report of a Case. Surg Today 2007; 37:305-7. [PMID: 17387562 DOI: 10.1007/s00595-006-3402-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Accepted: 11/11/2006] [Indexed: 10/23/2022]
Abstract
A 55-year-old man presented with a massive hemorrhage from the ileal conduit of the left ureter. He had previously undergone a total pelvic exenteration with ileal conduit construction of the ureters due to rectal carcinoma. A right ureteroarterial fistula developed, and he underwent an excision of the right common iliac artery with a femorofemoral bypass and a right cutaneous ureterostomy. Seven months later, a pseudoaneurysm developed at the aortic stump, followed by an aorto-ileal-conduit fistula. The patient was treated successfully with endovascular stent grafting and has since showed a good recovery no sign of graft infection or a recurrence of hematuria at the 10-month follow-up.
Collapse
Affiliation(s)
- Hiroyuki Ishibashi
- Department of Vascular Surgery, Aichi Medical University, Nagakute, Aichi, 480-1195, Japan
| | | | | | | | | | | | | |
Collapse
|
17
|
|
18
|
Jo KW, Hong Y, Han JH, Lee JK, Hong SB. A Case of Pulmonary Artery-bronchial Fistula with Massive Hemoptysis due to Pulmonary Tuberculosis. Tuberc Respir Dis (Seoul) 2007. [DOI: 10.4046/trd.2007.63.5.430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kyung-Wook Jo
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - YoonKi Hong
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung-Hye Han
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae-Keun Lee
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sang-Bum Hong
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| |
Collapse
|
19
|
Sánchez I, Escudero-Rodríguez J, Orellana-Fernández G, Dilmé-Muñoz J, Surcel P, Davins-Riu M, Romero-Carro J, Sirvent González M. Tratamiento endovascular de la patología aórtica excepcional. ANGIOLOGIA 2006. [DOI: 10.1016/s0003-3170(06)75005-2] [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]
|
20
|
Munneke G, Loosemore T, Smith J, Thompson M, Morgan R, Belli AM. Pseudoaneurysm after aortic coarctation repair presenting with an aortobronchial fistula successfully treated with an aortic stent graft. Clin Radiol 2006; 61:104-8. [PMID: 16356824 DOI: 10.1016/j.crad.2005.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2005] [Revised: 07/04/2005] [Accepted: 07/07/2005] [Indexed: 11/21/2022]
Affiliation(s)
- G Munneke
- Department of Interventional Radiology, St George's Hospital, London, UK.
| | | | | | | | | | | |
Collapse
|
21
|
Quintana AL, Aguilar EM, Heredero AF, Riambau V, Paul L, Acín F. Aortobronchial fistula after aortic coartactation. J Thorac Cardiovasc Surg 2006; 131:240-3. [PMID: 16399325 DOI: 10.1016/j.jtcvs.2005.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2005] [Revised: 09/30/2005] [Accepted: 10/07/2005] [Indexed: 11/23/2022]
Affiliation(s)
- Alfonso L Quintana
- Department of Angiology and Vascular Surgery, Getafe University Hospital, Madrid, Spain
| | | | | | | | | | | |
Collapse
|
22
|
Kaw LL, Owens EL, Kansal N. Endovascular Repair of an Aortopulmonary Fistula via the Axillary Artery. Ann Vasc Surg 2005; 19:487-91. [PMID: 15981126 DOI: 10.1007/s10016-005-4641-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A 62-year-old man presented with several months of progressive hemoptysis. He has a history of aortobifemoral bypass and thoracofemoral bypass grafts, which were both removed due to infection. Evaluation with multiple imaging modalities revealed a descending thoracic aortic pseudoaneurysm around the retained Dacrontrade mark graft with bronchiectatic changes and consolidation of the adjacent left lower lobe. No evidence of direct arterial communication between the aorta and the bronchioles was ever demonstrated, but an aortopulmonary fistula was suspected. Endovascular repair with several Excluder aortic cuffs stacked in the thoracic aorta was successfully performed via the axillary artery. Exclusion of the pseudoaneurysm with no evidence of endoleak was noted on computed tomography 2 months postoperatively, at which time the patient reported complete resolution of his hemoptysis. To our knowledge, this is the first report of endovascular repair of an aortopulmonary fistula via the axillary artery.
Collapse
Affiliation(s)
- Leoncio L Kaw
- Division of Cardiothoracic and Vascular Surgery, Scripps Clinic/Scripps Green Hospital, San Diego, CA, USA
| | | | | |
Collapse
|
23
|
López-Benítez R, Richter GM, Luburic A, Böckler D, Kauffmann G, Hallscheidt PJ. False lumen embolization for type B dissection complicated by hemoptysis. Eur J Vasc Endovasc Surg 2005; 30:370-5. [PMID: 15975835 DOI: 10.1016/j.ejvs.2005.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2004] [Accepted: 04/18/2005] [Indexed: 10/25/2022]
Abstract
In this report, we describe successful treatment of a patient with hemoptysis by false lumen embolization of a type B aortic dissection.
Collapse
Affiliation(s)
- R López-Benítez
- Department of Radiology, Heidelberg University Klinikum, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | | | | | | | | | | |
Collapse
|
24
|
Slonim SM, Adams MT, Kollmeyer KR. Endovascular repair of an aortopulmonary artery fistula with use of controlled-release coils. J Vasc Interv Radiol 2004; 15:861-4. [PMID: 15297591 DOI: 10.1097/01.rvi.0000128814.82738.dd] [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: 11/26/2022] Open
Abstract
Aortopulmonary artery fistula is traditionally treated surgically. The present case report describes endovascular repair of an aortopulmonary artery fistula in a patient in whom two thoracotomies had been performed. The fistula occurred at the site of a pseudoaneurysm from the proximal anastomosis of a graft placed to treat a type B aortic dissection. Two controlled-release endovascular coils were positioned across the fistula, resulting in immediate closure. The fistula remains closed with resolution of the pseudoaneurysm after more than 3 years of follow-up.
Collapse
Affiliation(s)
- Suzanne M Slonim
- Section of Interventional Radiology, Methodist Hospitals of Dallas, Pavilion II, Suite 440, 221 West Colorado Boulevard, Dallas, Texas 75208, USA.
| | | | | |
Collapse
|
25
|
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]
|
26
|
Abstract
BACKGROUND Thoracic aortic dissections, ruptures, fistulae, and aneurysms pose a unique surgical challenge. Traditional repair of thoracic aortic aneurysms involves thoracotomy with graft interposition. Despite advances in perioperative care and both total and partial cardiopulmonary bypass, conventional surgery carries a significant morbidity and mortality. Principal complications include bleeding, paraplegia, stroke, cardiac events, pulmonary insufficiency, and renal failure. Recent enthusiasm for innovative endovascular therapies to treat aortic disease has spurred many centers to investigate endoluminal grafting of the thoracic aorta. Early reports on endovascular repair using custom made "first generation devices" demonstrated the technique to be feasible with a mortality and morbidity comparable to open repair. METHODS AND RESULTS From February 2000 to February 2001, endovascular stent graft repair of the thoracic aorta was performed in 46 patients (mean age 70; 29 male and 17 female) using the Gore Excluder. Twenty-three patients (50%) had atherosclerotic aneurysms, fourteen patients (30%) had dissections, three patients (7%) had aortobronochial fistulas, three patients (7%) had pseudoaneurysms, two patients (4%) had traumatic ruptures, and one patient (2%) had a ruptured aortic ulcer. Patient characteristics, procedural variables, outcomes, and complications were recorded. All patients were followed with chest CT scans at 1, 3, 6, and 12 months. Mean follow up was 9 months ranging from 1 to 15 months. All procedures were technically successful. There were no conversions. Average duration of the procedure was 120 minutes. Average length of stay was 6 days, but most patients left the hospital within 4 days (64%) after endoluminal grafting. Overall morbidity was 23%. Two patients (4%) had endoleaks that required a second procedure for successful repair. Two patients (4%) died in the immediate postoperative period. There were no cases of paraplegia. At follow-up, one patient had an endoleak found the day after the procedure and another patient had an endoleak 6 moths post procedure. Both were treated successfully with additional stent grafts. There were no cases of migration. One patient died of a myocardial infarction 6 months after graft placement. The Gore Excluder device was voluntarily recalled on February 26, 2001. Therefore, from June 2000 to January 2001, 37 patients underwent endovascular stent graft repair of the thoracic aorta for various disease entities using our customized thoracic graft (Endomed). Twenty-seven patients (73%) had aneurysms, six (16%) had dissections, two (5%) had pseudoaneurysms, one (2%) had a traumatic transection, and one patient (2%) had an embolizing ulcer. Patients were followed with CT scans at 1, 3, 6, and 12 months. All procedures were technically successful. There were no conversions. The average age was 68 years.(17-87). And the male and female ratio was 24/13. One patient died in the operating room from iliac rupture and one died from embolization/stroke in the immediate postoperative period. Two patients died within 30 days from comorbid factors. The total 30-day mortality was 10%. Two patients had endoleaks. One returned to the operating room and needed an additional cuff. The other had a small leak in a proximal dissection that is being followed. There were no cases of paraplegia. CONCLUSION Thoracic endoluminal grafting is a safe and feasible alternative to open graft repair and can be performed successfully with good results. Early data suggest that an endoluminal approach to these disease entities maybe favorable to open resection and graft replacement. Technical details of Endoluminal stent grafting of the thoracic aorta for different disease entities have been discussed at length.
Collapse
Affiliation(s)
- Venkatesh Ramaiah
- Department of Cardiovascular and Endovascular Surgery, Arizona Heart Institute, 2632 N. 20th Street, Phoenix, AZ 85006, USA.
| | | | | |
Collapse
|
27
|
Davison BD, Ring DH, Bueno R, Jaklitsch MT. Endovascular stent-graft repair of a pulmonary artery-bronchial fistula. J Vasc Interv Radiol 2003; 14:929-32. [PMID: 12847202 DOI: 10.1097/01.rvi.0000082825.75926.82] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Herein the authors present a case of a 51-year-old man who presented with dramatic angiographically demonstrated massive hemorrhage from a pulmonary artery-to-bronchial stump fistula 3 months after right upper lobectomy. The patient was successfully treated with endovascular placement of a covered stent.
Collapse
Affiliation(s)
- Brian D Davison
- Department of Radiology, Brigham & Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115, USA.
| | | | | | | |
Collapse
|
28
|
Chabbert V, Otal P, Bouchard L, Soula P, Van TT, Kos X, Meites G, Claude C, Joffre F, Rousseau H. Midterm outcomes of thoracic aortic stent-grafts: complications and imaging techniques. J Endovasc Ther 2003; 10:494-504. [PMID: 12932160 DOI: 10.1177/152660280301000314] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the midterm outcomes of thoracic aortic stent-grafting and the performance of computed tomographic angiography (CTA), radiography, and magnetic resonance angiography (MRA) in endograft surveillance. METHODS Forty-seven patients with traumatic thoracic aortic ruptures (n=16), aneurysms (n=14), false aneurysms (n=3), penetrating ulcers (n=3), and dissections (n=11) treated with stent-grafts were monitored in follow-up using chest radiography and CTA in all patients and MRA in 23 patients. Two perpendicular maximal aortic diameters, the sum of these diameters, and the elliptical cross-sectional area were determined and compared to baseline for the entire group and in subgroup analyses according to lesion type. CTA, MRA, and radiography were compared for their ability to detect endoleak, monitor stent-graft configuration, and measure aortic diameters. RESULTS The mortality rate was 8.5%. Severe complications were observed in 14.8% (6% neurological complications); 12 (25.5%) patients had primary endoleaks. Over a mean 11-month follow-up (range 0.25-46 months), the aortic diameters decreased for all patients without endoleak (p<0.001). In the diameter/area subgroup analyses, only the traumatic rupture cohort demonstrated significant decreases in all 4 measurements. CTA and MRA measurements correlated well, but chest radiography was superior to both for visualizing stent-graft shape. In terms of endoleak detection, MRA missed only 1 (12.5%) endoleak (type II) seen on CTA; there were no false positive results with MRA. CONCLUSIONS Morbidity and mortality observed after thoracic stent-grafting are acceptable. Radiography is better for monitoring stent-graft conformation, while CTA provides the best overall morphological information. The performance of MRA in endoleak detection is encouraging.
Collapse
Affiliation(s)
- Valérie Chabbert
- Department of Radiology, University of Rangueil, Toulouse, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
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: 96] [Impact Index Per Article: 4.6] [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.
Collapse
Affiliation(s)
- Marco Picichè
- Cardiac Surgery Department, San Bortolo Hospital, Vicenza, Italy
| | | | | | | |
Collapse
|
30
|
Chabbert V, Otal P, Bouchard L, Soula P, Van TT, Kos X, Meites G, Claude C, Joffre F, Rousseau H. Midterm Outcomes of Thoracic Aortic Stent-Grafts:Complications and Imaging Techniques. J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<0494:mootas>2.0.co;2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
31
|
Abstract
BACKGROUND Aneurysmal dilatation in Takayasu's arteritis is a recognized complication; however, fistula formation, especially to the esophagus, is very rare. METHODS A 22-year-old male presented with severe hematemesis. Investigation by means of esophagogastroscopy and CT scan revealed a saccular aneurysm in the proximal descending aorta with communication to the esophagus. The patient was taken to theater, the aneurysm excised and replaced by a graft. RESULTS Gross examination of the aneurysm showed multiple points of outpouching from the aneurysm. Histopathological examination of the showed marked intimal fibromyxoid thickening, loss of outer medial muscle and elastic fibers and marked fibrosis of the adventitial layer. The histological features were in keeping with Takayasu's arteritis. No evidence of tuberculosis was noted. CONCLUSIONS This case illustrates an unusual complication of Takayasu's arteritis, in the form of a fistula between the aorta and the esophagus, which resulted in massive hematemesis and the ultimate demise of the patient.
Collapse
Affiliation(s)
- A Reddi
- Department of Cardiothoracic Surgery, Nelson R Mandela School of Medicine, University of Natal and Wentworth Hospital, Durban, South Africa
| | | |
Collapse
|
32
|
Dilmé-Muñoz J, Escudero-Rodríguez J, Llauger-Roselló J, García-Moll Marimón X, Barreirro-Veiguela J, Viver-Manresa E. Exclusión endoprotésica de fístula aortobronquial con hemoptisis. ANGIOLOGIA 2003. [DOI: 10.1016/s0003-3170(03)74834-2] [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]
|
33
|
Thompson CS, Gaxotte VD, Rodriguez JA, Ramaiah VG, Vranic M, Ravi R, DiMugno L, Shafique S, Olsen D, Diethrich EB. Endoluminal stent grafting of the thoracic aorta: initial experience with the Gore Excluder. J Vasc Surg 2002; 35:1163-70. [PMID: 12042726 DOI: 10.1067/mva.2002.122885] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE The purpose of this study was to describe our experience with endoluminal graft repair of a variety of thoracic aorta pathologies with a commercially developed device currently under investigation. Our patient population included patients eligible for open surgical repair and those with prohibitive surgical risk. METHODS From February 2000 to February 2001, endovascular stent-graft repair of the thoracic aorta was performed in 46 patients (mean age, 70 years; 29 male and 17 female patients) with the Gore Excluder. Twenty-three patients (50%) had atherosclerotic aneurysms, 14 patients (30%) had dissections, three patients (7%) had aortobronchial fistulas, three patients (7%) had pseudoaneurysms, two patients (4%) had traumatic ruptures, and one patient (2%) had a ruptured aortic ulcer. Patient characteristics, procedural variables, outcome, and complications were recorded. All patients were followed with chest computed tomographic scans at 1, 3, 6, and 12 months. Follow-up period ranged from 1 month to 15 months, with a mean of 8.5 months. RESULTS All the procedures were technically successful. There were no conversions. Average duration of the procedure was 120 minutes. Average length of stay was 6 days, but most patients (64%) left the hospital within 4 days after endoluminal grafting. The overall morbidity rate was 23%. Two patients (4%) had endoleaks that necessitated a second procedure for successful repair. Two patients (4%) died in the immediate postoperative period. There were no cases of paraplegia. At follow-up examination, one patient had an endoleak found the day after the procedure and another patient had an endoleak 6 months after the procedure. Both cases were treated successfully with additional stent-grafts. There were no cases of migration. One patient died of a myocardial infarction 6 months after graft placement. In patients treated for aneurysm (n = 23), the aneurysm diameter ranged from 5.0 to 9.5 cm (mean, 6.8 cm). Residual sac measurements were obtained at 1, 6, and 12 months, with mean sac reductions of 0.59 cm, 0.77 cm, and 0.85 cm, respectively. In three cases, the sac remained unchanged, without evidence of endoleak. CONCLUSION Thoracic endoluminal grafting with the Gore Excluder is a safe and feasible alternative to open graft repair and can be performed successfully with good results. Early data suggest an endoluminal approach to these disease entities may be favorable over classical resection and graft replacement.
Collapse
Affiliation(s)
- Charles S Thompson
- Department of Cardiovascular and Endovascular Surgery, Arizona Heart Institute and Hospital, 2632 N 20th Street, Phoenix, AZ 85006, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Warren FM, Cohen JI, Nesbit GM, Barnwell SL, Wax MK, Andersen PE. Management of carotid 'blowout' with endovascular stent grafts. Laryngoscope 2002; 112:428-33. [PMID: 12148848 DOI: 10.1097/00005537-200203000-00004] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES/HYPOTHESIS Since 1992, endovascular techniques for vascular occlusion and stenting have evolved significantly. Endovascular occlusion of the carotid artery has been used in the management of carotid "blowout." Although it seems logical to expand this application to the use of arterial stents to repair rather than occlude the artery when cerebral cross-circulation is inadequate, concerns remain regarding the placement of a foreign body in a contaminated field. The purpose of the present report is to describe our experience with endovascular stents for control of carotid hemorrhage. STUDY DESIGN Retrospective case review. METHODS Retrospective review of three cases of acute or threatened carotid hemorrhage managed with endovascular stent placement. RESULTS Two patients presented with acute carotid blowout, and one patient with a probable sentinel bleed. All patients previously had been heavily treated with surgery and irradiation: Two had developed pharyngocutaneous fistulas, and one had an open wound filled with tumor that surrounded the carotid artery. All were thought to be at significant risk for stroke if the carotid artery was occluded. In all three patients, stent placement resolved the acute hemorrhage. Mean duration of follow-up was 8.3 months. In two patients, the stent became exposed, ultimately thrombosed or extruded, or both. The third patient had no residual sequelae of stenting but died 3 months later. CONCLUSION When an unacceptable risk of cardiovascular accident makes occlusion unwise, acute carotid hemorrhage can be successfully managed with directed placement of endovascular stents, but the long-term sequelae of placing these foreign bodies in a field with ongoing contamination make this a temporizing rather than permanent measure for use while more definitive long-term solutions are pursued.
Collapse
Affiliation(s)
- Frank M Warren
- Department of Otolaryngology--Head and Neck Surgery, Oregon Health Sciences University, Portland 97201-3098, USA
| | | | | | | | | | | |
Collapse
|
35
|
Thompson CS, Ramaiah VG, Rodriquez-Lopez JA, Vranic M, Ravi R, DiMugno L, Shafique S, Olsen D, Diethrich EB. Endoluminal stent graft repair of aortobronchial fistulas. J Vasc Surg 2002; 35:387-91. [PMID: 11854740 DOI: 10.1067/mva.2002.118583] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe our experience with endoluminal stent graft repair of aortobronchial fistulas. METHODS We reviewed the records of patients treated with endoluminal stent grafting of aortobronchial fistulas at a private teaching hospital. All patients underwent the following diagnostic studies: computed tomography, angiography, bronchoscopy, and transesophageal echocardiography. With standard endovascular techniques, two different devices were implanted. RESULTS Between March 1997 and October 2000, we treated four patients with postsurgical fistulas. The patients were diagnosed with hemoptysis between 3 and 23 years after aortic replacement grafting for thoracic aneurysms. Diagnostic studies varied in their ability to find the fistula. Transesophageal echocardiography most reliably demonstrated the fistula in the patients. All were successfully treated by exclusion with endoluminal stent grafting. The patients had no complications and no further episodes of hemoptysis. CONCLUSION Endoluminal stent grafting of aortobronchial fistulas is feasible and may become the preferred method of management in patients at high risk.
Collapse
Affiliation(s)
- Charles S Thompson
- Department of Cardiovascular Surgery, Arizona Heart Institute and Arizona Heart Hospital, Phoenix 85016, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Milner R, Bavaria JE, Baum RA, Carpenter JP, Velazquez OC, Brinster D, Fairman RM. Thoracic aortic stent grafts. Semin Roentgenol 2001; 36:340-50. [PMID: 11715329 DOI: 10.1053/sroe.2001.29163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- R Milner
- Department of Surgery, Division of Vascular Surgery, University of Pennsylvania Medical Center, 3400 Spruce St, 4 Silverstein Pavilion, Philadelphia, PA 19104, USA
| | | | | | | | | | | | | |
Collapse
|
37
|
Smayra T, Otal P, Soula P, Chabbert V, Cérène A, Joffre F, Rousseau H. Pseudoaneurysm and Aortobronchial Fistula After Surgical Bypass for Aortic Coarctation:Management With Endovascular Stent-Graft. J Endovasc Ther 2001. [DOI: 10.1583/1545-1550(2001)008<0422:paafas>2.0.co;2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
38
|
Smayra T, Otal P, Soula P, Chabbert V, Cérène A, Joffre F, Rousseau H. Pseudoaneurysm and aortobronchial fistula after surgical bypass for aortic coarctation: management with endovascular stent-graft. J Endovasc Ther 2001; 8:422-8. [PMID: 11552735 DOI: 10.1177/152660280100800412] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the endovascular repair of an aortobronchial fistula at the distal anastomosis of a complex thoracic graft. CASE REPORT A 61-year-old man operated 18 years prior for aortic coarctation presented with hemoptysis. An aortobronchial fistula was suspected, but spiral computed tomography and angiography showed only a small pseudoaneurysm at the distal anastomosis without revealing the fistulous tract. A Talent stent-graft was successfully deployed through a femoral access, but the large delivery system injured the external iliac artery, producing a retroperitoneal hemorrhage. Prompt balloon occlusion of the aorta and subsequent bypass graft repair of the arterial injury prevented serious sequelae. The patient recovered without further complications. Follow-up imaging to 2 years has documented exclusion of the pseudoaneurysm with no hemoptysis or signs of new false aneurysm formation. CONCLUSIONS Endovascular exclusion of anastomotic pseudoaneurysms even in complicated cases can be an efficient treatment option, but the procedure must be carefully planned and executed in order to achieve good results.
Collapse
Affiliation(s)
- T Smayra
- Department of Radiology, Hôpital Rangueil, Toulouse, France
| | | | | | | | | | | | | |
Collapse
|
39
|
Dorweiler B, Dueber C, Neufang A, Schmiedt W, Pitton MB, Oelert H. Endovascular treatment of acute bleeding complications in traumatic aortic rupture and aortobronchial fistula. Eur J Cardiothorac Surg 2001; 19:739-45. [PMID: 11404125 DOI: 10.1016/s1010-7940(01)00711-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Herein we report our experience in placement of endovascular stentgrafts in the descending aorta in patients with acute bleeding complications due to traumatic rupture or aortobronchial fistula. METHODS Six patients (one woman, five men, mean age 47+/-19 years) were treated from September 1995 to February 2000 by implantation of endovascular stentgrafts in the descending aorta. Indications included traumatic ruptures of the aortic isthmus (n=3) and aortobronchial fistulas (n=3). All procedures were performed under general anaesthesia. The implants were introduced under fluoroscopic guidance via the aorta (n=1), the iliac (n=4) or femoral (n=2) artery, respectively. RESULTS All aortobronchial fistulas and ruptures were sealed up successfully. There was no perioperative morbidity and no procedure-related morbidity except one patient who received aortofemoral reconstruction because of iliac occlusive disease. All patients are alive and well after a mean follow-up of 31 months (range 6-60). Two patients had recurrent hemoptysis, in one case, the patient received a second implant (distal extension), the other patient was managed conservatively. CONCLUSION Endovascular treatment by a stentgraft is a safe and reliable procedure in the management of acute bleeding complications in patients with aortic rupture or aortobronchial fistulas.
Collapse
Affiliation(s)
- B Dorweiler
- Department of Cardiothoracic and Vascular Surgery, University Hospital, Johannes-Gutenberg University, Langenbeckstrasse 1, 55101, Mainz, Germany.
| | | | | | | | | | | |
Collapse
|
40
|
Deguchi J, Furuya T, Tanaka N, Nobori M, Seki Y, Nomura Y, Umehara I, Saito H, Miyata T. Successful management of tracheo-innominate artery fistula with endovascular stent graft repair. J Vasc Surg 2001; 33:1280-2. [PMID: 11389430 DOI: 10.1067/mva.2001.114997] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Tracheo-innominate artery fistula is a highly lethal complication after tracheostomy. A 37-year-old man who had undergone a tracheostomy 14 years earlier because of dysphagia after brain surgery had a tracheo-innominate artery fistula with exsanguinating hemorrhage from his tracheostomy site. After temporary control of the bleeding, a stent graft was implanted in the innominate artery through the brachial artery. The patient recovered uneventfully and remained well 14 months after the procedure, with no sign of infection. Endovascular stent grafting may be the treatment of choice for patients with tracheo-innominate artery fistula.
Collapse
Affiliation(s)
- J Deguchi
- Department of Surgery, Asahi General Hospital, Tokyo, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
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
| | | | | | | | | |
Collapse
|
42
|
Abstract
A 5-year-old girl with pulmonary atresia, ventricular septal defect, hypoplastic pulmonary arteries, and multiple pulmonary artery reconstructive procedures presented with an enlarging pulmonary artery pseudoaneurysm. A previous attempt to occlude the aneurysm was unsuccessful and the aneurysm continued to enlarge. We describe the percutaneous placement of an endovascular stent graft to occlude the aneurysm. This novel use of a covered graft effectively treated a potentially lethal problem without reoperative thoracotomy or sternotomy.
Collapse
Affiliation(s)
- R L Hannan
- Division of Cardiology, Miami Children's Hospital, Florida, USA.
| | | | | | | |
Collapse
|
43
|
Caiati JM, Marin ML, Flores RM, Smith CR, Martin EC, Todd GJ. Endovascular management of an aortobronchial fistula arising after resection of a primary aortic sarcoma: a case report. VASCULAR SURGERY 2001; 35:73-9. [PMID: 11668373 DOI: 10.1177/153857440103500116] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The experience with the use of endovascular covered stents for aortic lesions has been growing. The early results of using endovascular covered stents for the exclusion of thoracic and infrarenal abdominal aortic aneurysms have been promising and are being investigated in multiple ongoing trials. Their usage for other aortic lesions has been reported sporadically, often as resourceful options in unusual and difficult clinical situations. The authors report a patient who had previously undergone resection of a thoracic aortic sarcoma and subsequently presented in extremis from an aortobronchial fistula. The evaluation and treatment of an aortic sarcoma and the successful urgent exclusion of an aortobronchial fistula through use of an endovascular covered stent are discussed.
Collapse
Affiliation(s)
- J M Caiati
- Division of Vascular Surgery, Columbia-Presbyterian Medical Center, New York, NY 10032, USA
| | | | | | | | | | | |
Collapse
|
44
|
VonFricken K, Karamanoukian HL, Ricci M, Taheri A, Bergsland J, Salerno TA. Aortobronchial fistula after endovascular stent graft repair of the thoracic aorta. Ann Thorac Surg 2000; 70:1407-9. [PMID: 11081914 DOI: 10.1016/s0003-4975(00)01683-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Endovascular stent graft repair of descending thoracic aortic aneurysms has been recently introduced as an alternative to conventional graft replacement of the diseased aorta. As experience with this new technique accumulates, complications may occur. We herein report the case of a patient in whom we observed distal migration with leak of an endovascular stent graft previously inserted in the descending thoracic aorta, associated with an aortobronchial fistula. The urgent surgical treatment undertaken, which consisted of graft replacement of the previously stented aorta, had a fatal outcome.
Collapse
Affiliation(s)
- K VonFricken
- Division of Cardiothoracic Surgery, Kaleida Health System, Buffalo General Hospital, SUNY at Buffalo, New York, USA
| | | | | | | | | | | |
Collapse
|
45
|
Eskandari MK, Makaroun MS, Abu-Elmagd KM, Billiar TR. Endovascular repair of an aortoduodenal fistula. J Endovasc Ther 2000; 7:328-32. [PMID: 10958300 DOI: 10.1177/152660280000700413] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To demonstrate the utility of endovascular stent-graft repair for the management of an unusual aortoduodenal fistula. METHODS AND RESULTS A 23-year-old man with an aortoduodenal fistula secondary to tumor necrosis was treated with a Corvita endoluminal stent-graft after several failed surgical attempts to repair the defect. At 2-year follow-up, the patient was clinically and radiographically devoid of any evidence of occult stent-graft infection. CONCLUSIONS This case illustrates the usefulness of endovascular repair for the treatment of a primary aortoduodenal fistula. Endovascular repair should be included in the armamentarium for the management of difficult aortoduodenal fistulas.
Collapse
Affiliation(s)
- M K Eskandari
- Division of General Surgery, The University of Pittsburgh Medical Center, Pennsylvania, USA.
| | | | | | | |
Collapse
|
46
|
|
47
|
Grabs AJ, Irvine CD, Lusby RJ. Stent-graft treatment for bleeding from a presumed aortoenteric fistula. J Endovasc Ther 2000; 7:236-9. [PMID: 10883962 DOI: 10.1177/152660280000700311] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe a technique for the endovascular treatment of aortoenteric fistula. METHODS AND RESULTS A 67-year-old man who had undergone aortobi-iliac grafting for aneurysmal disease 8 years previously presented with life-threatening upper gastrointestinal hemorrhage. Endoscopy after resuscitation did not identify the source of the bleeding. Computed tomographic (CT) scanning and angiography revealed pseudoaneurysm formation at the upper anastomosis 1 cm below the renal arteries. Measurements were taken for endovascular repair. Uncomplicated emergency aortic endografting for exclusion of the pseudoaneurysm was performed using a 28-mm x 3.75-cm AneuRx device. Gastrointestinal hemorrhage ceased. CT scanning at 6 months confirmed the absence of a pseudoaneurysm, and the patient remains symptom free at 18 months. CONCLUSIONS Endovascular treatment of aortoenteric fistula may represent a technique for treating gastrointestinal hemorrhage and for lessening the morbidity and mortality of open repair.
Collapse
Affiliation(s)
- A J Grabs
- Department of Vascular Surgery, Concord Hospital, Sydney, Australia.
| | | | | |
Collapse
|
48
|
|
49
|
Biasi GM. Aortocaval fistula: a challenge for endovascular management. JOURNAL OF ENDOVASCULAR SURGERY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR ENDOVASCULAR SURGERY 1999; 6:378. [PMID: 10893144 DOI: 10.1583/1074-6218(1999)006<0378:afacfe>2.0.co;2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- G M Biasi
- Department of Vascular Surgery, Bassini Teaching Hospital, University of Milan, Italy.
| |
Collapse
|