Haiou Hu1, Cristiano Spadaccio1,2, Junming Zhu1, Chengnan Li1, Zhiyu Qiao1, Yongmin Liu1, Marc R Moon3, Lizhong Sun1. 1. 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. 2. Department of Cardiac Surgery, University of Glasgow Institute of Cardiovascular and Medical Sciences, Golden Jubilee National Hospital, Glasgow, UK. 3. Washington University School of Medicine, St Louis, Missouri, USA.
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.
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 patientsdied during follow-up, the third was alive in good condition. In the endovascular repair group (n = 7), one patientdied 22 days after the endovascular repair because of massive hemoptysis and another patientdied 4 days after the procedure because of cerebral infarction. In the medium term, two patientsdied of massive hemoptysis, and one was lost at follow-up. In the open surgery group (n = 4), one patientdied 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.