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Combined endovascular and surgical approach for aortobronchial fistula.
- Source :
-
The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2014 Nov; Vol. 148 (5), pp. 2108-11. Date of Electronic Publication: 2014 Jan 21. - Publication Year :
- 2014
-
Abstract
- Objective: The perioperative outcomes of the endovascular approach to aortobronchial fistula have been favorable. However, it is uncertain whether thoracic endovascular aneurysm repair (TEVAR) alone provides a complete and durable cure for an aortobronchial fistula. TEVAR does nothing to address the issue of the defect in the respiratory tract, leaving the patient at risk of aortobronchial fistula recurrence and/or stent graft infection. The authors believe that the bronchial defect should be addressed.<br />Methods: Over the last 10 years, 5 patients were treated for an aortobronchial fistula using a combined endovascular and surgical approach (primary treatment in 3 patients and secondary after TEVAR in 2 patients). All the patients underwent emergency stent graft placement and concomitant (n=1) or staged (n=4) open repair including pulmonary resection with coverage of the stent graft using muscle or pleural flaps. All patients received a 6-week course of broad-spectrum intravenous antibiotics followed by lifelong oral antibiotics.<br />Results: All patients survived the surgical procedure. After a mean follow-up of 23.2 months, 4 patients are asymptomatic and postprocedure computed tomography scans were unremarkable. One patient treated for an aortobronchial fistula after TEVAR was readmitted 4 months after surgical conversion. Stent graft explantation and silver-coated tube graft replacement of the descending thoracic aorta were performed for severe mediastinitis with associated thoracic stent graft infection. The postoperative course of this patient was uneventful.<br />Conclusions: Emergency TEVAR for an aortobronchial fistula is an appealing strategy for this devastating complication. However, to achieve a lasting result, direct contact between the stent graft and the pulmonary tissue should be avoided to prevent further erosive damage. Concomitant or staged repair should entail primary repair or resection and anastomosis of the bronchus and/or pulmonary resection with coverage of the stent graft using muscle or pleural flaps combined with broad-spectrum intravenous antibiotic therapy. Long-term surveillance and continued investigation are warranted.<br /> (Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Aged, 80 and over
Anti-Bacterial Agents administration & dosage
Aorta, Thoracic diagnostic imaging
Aortic Diseases diagnosis
Aortography methods
Blood Vessel Prosthesis adverse effects
Bronchial Fistula diagnosis
Device Removal
Female
Humans
Male
Mediastinitis etiology
Mediastinitis surgery
Middle Aged
Pneumonectomy
Positron-Emission Tomography
Prosthesis-Related Infections etiology
Prosthesis-Related Infections surgery
Reoperation
Retrospective Studies
Stents adverse effects
Surgical Flaps
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Vascular Fistula diagnosis
Aorta, Thoracic surgery
Aortic Diseases surgery
Blood Vessel Prosthesis Implantation adverse effects
Blood Vessel Prosthesis Implantation instrumentation
Bronchial Fistula surgery
Endovascular Procedures adverse effects
Endovascular Procedures instrumentation
Vascular Fistula surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1097-685X
- Volume :
- 148
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- The Journal of thoracic and cardiovascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 24560418
- Full Text :
- https://doi.org/10.1016/j.jtcvs.2014.01.018