Back to ePosters

Objective:
Evaluate the use of thoracic endovascular aortic repair (TEVAR) to exclude secondary aortobronchial fistulas to prevent fatal hemorrhage when submitted to a long-term follow-up.
Methods:
Retrospective review of patients with prior history of aortic repairs presenting with massive hemoptysis, and who underwent endovascular exclusion of their aortobronchial fistulas at a single institution. Demographics, clinical history, outcomes, need for re-intervention, and radiological follow-up were collected for each patient.
Results:
Six patients, 4 males, 2 females, with an initial average age of 47.2 years (range 32 - 60 years) presented with massive hemoptysis and a prior history of aortic repair: coarctation (n=3), aortic transection (n=2), and aberrant right subclavian artery aneurysm (n=1). Length of time from open repair to presentation averaged 18.7 years (range 3 - 31 years). Diagnosis and treatment was often delayed averaging 33.3 days (range 1.5 - 150 days) from onset of symptoms to endovascular exclusion.
There were no operative mortalities, average length of hospital stay was 8.3 +/- 0.5 days. Bronchoscopic cultures yielded one MRSA positive culture, and antibiotic were administered for 4-6 weeks. Follow-up of 75.3 +/-9 months revealed two recurrent episode of hemoptysis at 6 and 9 years, which were treated with a second TEVAR, again with no mortalities or adverse events.
Conclusion:
In patients with massive hemoptysis and a prior open or endovascular thoracic aortic repair presence of an aortobronchial fistula must be suspected. As opposed to TEVAR for aorto-esophageal fistulas, TEVAR for secondary aorto-bronchial fistulas appears to offer long-term exclusion. Lifetime surveillance is still recommended as to achieve a durable exclusion.