1
|
Bugge AS, Kvitting JPE, Sundset A, Birkeland S. Lung autotransplantation and extra-anatomic bypass to treat an aortobronchial fistula after previous surgery for aortic coarctation. J Card Surg 2021; 36:2924-2927. [PMID: 34018253 DOI: 10.1111/jocs.15660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 11/28/2022]
Abstract
Lung autotransplantation can be a surgical alternative to gain access to the posterior mediastinum and the thoracic portion of the descending aorta through a sternotomy. We present a case of hemoptysis and bronchial obstruction due to a presumed infected aortobronchial fistula, secondary to stent graft placement in a patient with multiple previous surgeries for aortic coarctation, treated with lung autotransplantation and an extra-anatomic bypass.
Collapse
Affiliation(s)
- Anders Standal Bugge
- Department of Cardiothoracic Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - John-Peder Escobar Kvitting
- Department of Cardiothoracic Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Arve Sundset
- Department of Respiratory Medicine, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Sigurd Birkeland
- Department of Cardiothoracic Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| |
Collapse
|
2
|
Hu H, Spadaccio C, Zhu J, Li C, Qiao Z, Liu Y, Moon MR, Sun L. Management of aortobronchial fistula: Experience of 14 cases. J Card Surg 2020; 36:156-161. [PMID: 33135245 DOI: 10.1111/jocs.15130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/19/2020] [Accepted: 09/27/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Aortobronchial fistula (ABF) is rare but lethal condition if left untreated, and the treatment still remains challenging. We retrospectively reviewed data at our Institution and report our experience in the management of ABF. METHODS From September 2010 to May 2019, 14 patients (13 men, average age 52 ± 11 years) with ABF were treated in our hospital. Three types of management were applied according to the patients' different clinical presentation, including conservative treatment, that is, antibiotic treatment (n = 3), endovascular repair (n = 7), and open surgery (n = 4). In the open surgery group, Dacron grafts were used, two cases received in situ descending thoracic aortic replacement through left thoracotomy and two cases received extra-anatomic bypass through median thoracoabdominal incision. RESULTS In the conservative treatment group (n = 3), two patients died during follow-up, the third was alive in good condition. In the endovascular repair group (n = 7), one patient died 22 days after the endovascular repair because of massive hemoptysis and another patient died 4 days after the procedure because of cerebral infarction. In the medium term, two patients died of massive hemoptysis, and one was lost at follow-up. In the open surgery group (n = 4), one patient died because of massive hemoptysis 2 days after his extra-anatomic bypass procedure, the remaining patients were alive in good condition at follow-up. CONCLUSIONS ABF is catastrophic if left untreated. Endovascular repair might be a reasonable temporary bridge solution in emergency cases, but is less durable in the long run. Open surgery, despite more challenging, provides a more definitive treatment for ABF.
Collapse
Affiliation(s)
- Haiou Hu
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Capital Medical University, Beijing, China
| | - Cristiano Spadaccio
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Capital Medical University, Beijing, China.,Department of Cardiac Surgery, University of Glasgow Institute of Cardiovascular and Medical Sciences, Golden Jubilee National Hospital, Glasgow, UK
| | - Junming Zhu
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Capital Medical University, Beijing, China
| | - Chengnan Li
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Capital Medical University, Beijing, China
| | - Zhiyu Qiao
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Capital Medical University, Beijing, China
| | - Yongmin Liu
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Capital Medical University, Beijing, China
| | - Marc R Moon
- Washington University School of Medicine, St Louis, Missouri, USA
| | - Lizhong Sun
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Capital Medical University, Beijing, China
| |
Collapse
|
3
|
Abstract
Aortobronchial fistulas (ABFs) are rare but fatal if left untreated. Hemoptysis is the most common symptom of the patients. ABFs may occur after any thoracic aortic lesions or maneuveurs for these lesions. The treatment of ABF can be surgical or thoracic endovascular aortic repair. Thoracic endovascular aortic repair can be a safe and less invasive procedure for the treatment of ABFs. However, ABFs might occur in much shorter time after thoracic endovascular aortic repair than any other etiologies. The prognoses of patients with ABFs are poor with a high morbidity and mortality. The selection of a suitable endovascular graft and avoidance of postinterventional complications might effectively prevent the occurrence of ABFs.
Collapse
Affiliation(s)
- Shi-Min Yuan
- Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, 389 Longdejing Street, Chengxiang District, Putian, 351100, Fujian Province, People's Republic of China.
| |
Collapse
|
4
|
Sakai M, Ozawa Y, Nakajima T, Ikeda A, Konishi T, Matsuzaki K. Thick lung wedge resection for acute life-threatening massive hemoptysis due to aortobronchial fistula. J Thorac Dis 2016; 8:E957-E960. [PMID: 27747035 DOI: 10.21037/jtd.2016.09.08] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Massive hemoptysis from an aortobronchial fistula due to thoracic aortic dissection is an extremely rare symptom, but is a potentially life-threatening condition. We report a case of acute massive hemoptysis due to aortobronchial fistula that was successfully controlled by a simple and rapid thick wedge resection of the lung with hematoma by using the black cartilage stapler. A 65-year-old man was admitted to our hospital with acute massive hemoptysis. After tracheal intubation, chest computed tomography revealed hematoma in the left lung and ruptured aortic dissection from the distal arch to the descending aorta. He was diagnosed with aortobronchial fistula and underwent an emergency surgery on the same day. We performed posterolateral thoracotomy. A dissecting aortic aneurysm (diameter, ~80 mm) with adhesion of the left upper lobe and the superior segment of the lower lobe was found. The lung parenchyma expanded with the hematoma. We stapled the upper and lower lobes by using the black cartridge stapler along the aortopulmonary window. Massive hemoptysis disappeared, and the complete aortic dissection appeared. Aortic dissection with adherent lung was excised, and graft replacement of the distal arch and descending thoracic aorta was performed. Proximal lung wedge resection using black cartridge stapler is a simple and quick method to control massive hemoptysis from aortic dissection; hence, this procedure is an effective option to control massive hemoptysis due to aortobronchial fistula. This technique could rapidly stop massive hemoptysis and prevent dissection of the adherent lung tissue and intra-thoracic bleeding.
Collapse
Affiliation(s)
- Mitsuaki Sakai
- Department of Thoracic Surgery, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Yuichiro Ozawa
- Department of Thoracic Surgery, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Tomomi Nakajima
- Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Akihiko Ikeda
- Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Taisuke Konishi
- Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Kanji Matsuzaki
- Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, Tsukuba, Japan
| |
Collapse
|
6
|
Dołęga-Kozierowski B, Sokratous K, Dyś K, Lis M, Ferenc S, Drelichowski S, Witkiewicz W. Aortoesophageal fistula as a complication of thoracic aorta aneurism stent grafting - a case report and literature review. Pol J Radiol 2012; 77:77-80. [PMID: 23269943 PMCID: PMC3529719 DOI: 10.12659/pjr.883635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 10/23/2012] [Indexed: 12/12/2022] Open
Abstract
Background: Endovascular stent grafting is performed in patients with aneurysms of aorta or other major vessels. The procedure is considered to be generally safe, with a low risk of complications, the most common of which include endoleaks, stenosis or thrombosis at the stagraft and itsmigration. Very rare complications include aortoesophageal and aortobronchial fistulas (0.5–1.7% cases). Case Report: A 64-year-old patient was admitted to our hospital with suspected aortoesophageal fistula. Two years prior, the patient had undergone a stent graft repair of the thoracic aorta at the local vascular surgery clinic. Both laboratory results and CT angiography revealed aortoesophageal fistula, which was also detected in endoscopic examination. Despite intensive treatment and preparation for surgery, the patient died 6 days after admission. Conclusions: Aortoesophageal and aortobronchial fistulas are among the most dangerous and difficult-to-treat complications in the treatment of thoracic aortic aneurysms by endovascular stent-grafting. This clearly indicates that preventive care and regular medical examinations are important to prevent their occurrence.
Collapse
Affiliation(s)
- Bartosz Dołęga-Kozierowski
- Lower Silesian Center for Diagnostic Imaging, Regional Specialist Hospital in Wrocław, Research and Development Center, Wrocław, Poland
| | | | | | | | | | | | | |
Collapse
|
7
|
Nguyen T, Peters P, McGahan T, Shah P. Staged management of a primary aortobronchial fistula: a novel approach using a trapezius flap repair. Heart Lung Circ 2012; 21:292-4. [PMID: 22464594 DOI: 10.1016/j.hlc.2012.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 11/06/2011] [Accepted: 01/17/2012] [Indexed: 11/17/2022]
Abstract
There have been few reported cases of management of an aortobronchial fistula. We describe the case of a 68 year-old male with a very high operative risk who had a successful staged management of a primary aortobronchial fistula. An endovascular stent was placed initially, however due to recurrence of the fistula a second stent was deployed within the first one some three months after. Fifteen months later he represented with massive haemoptysis, severe cachexia and at this stage the best course of surgical management was thought to be lobectomy via thoracotomy followed by trapezius flap overlay covering the exposed stent and separating it from the remaining lung.
Collapse
Affiliation(s)
- Tam Nguyen
- Department of Cardiothoracic Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | | | | |
Collapse
|
10
|
Wheatley GH. Stent-graft repair of aortobronchial fistula: who are we kidding? J Endovasc Ther 2009; 16:733-4. [PMID: 19995114 DOI: 10.1583/09-2800c.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Grayson H Wheatley
- Department of Cardiovascular and Endovascular Surgery, Arizona Heart Institute, Phoenix, Arizona 85006, USA.
| |
Collapse
|