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Have We Gone Too Far? Endovascular Stent Graft Repair of Aortobronchial Fistulas
G. H. Wheatley, A. Nunez, O. Preventza, V. Ramaiah, J. Rodriguez-Lopez, J. Williams, D. Olsen, E. B. Diethrich*. Arizona Heart Institute, Phoenix, AZ,
BACKGROUND: Although endovascular repair of the descending thoracic aorta (DTA) has emerged as a viable treatment option, little is known about its potential to treat patients diagnosed with aortobronchial fistulas (ABF). We reviewed our comprehensive thoracic endografting experience with regards to the endovascular management and subsequent outcome of patients with ABFs in order to assess whether endovascular stent graft repair is a realistic option.
METHODS: Between February 2000 and November 2005, 255 patients were successfully treated with an ELG to the DTA. Indications for intervention included: atherosclerotic aneurysms (109/255, 42.7%), acute and chronic dissections (75/25, 29.4%), miscellaneous (36/255, 16.7%), penetrating aortic ulcers (30/255, 11.8%) and ABFs (7/255, 2.7%).
RESULTS: Average patient age was 73.4±10.1 years, with 3 male patients (3/7, 42.9%) and 4 female patients (4/7, 57.1%). All patients presented with hemoptysis, with one patient (1/7, 14.3%) requiring pre-operative blood transfusion. Five patients (5/7, 71.4%) were diagnosed with atherosclerotic aneurysms and 2 patients (2/7, 28.6%) had pseudoaneurysms associated with prior open surgical repair. Patients were treated for one week with empiric antibiotics following ELG deployment. There were no endoleaks (0/7, 0%), no incidences of paraplegia (0/7, 0%) and no ELG infections (0/7, 0%). Survival was 100% (7/7) at both 30-days and 1-year. Follow-up computed tomography was available for all 7 patients (7/7, 100%), with an average of 11.2±3.6 months follow-up.
CONCLUSIONS: Endovascular management of ABFs appears to be safe and well-tolerated, even high surgical risk patients, with minimal risk of prosthesis infection. Long-term surveillance and continued investigation are warranted.
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