Thoracic endovascular aortic repair of aortobronchial fistulas

Abstract

Thoracic endovascular aortic repair of aortobronchial fistulas is an emerging treatment modality for this highly lethal condition. The feasibility and long-term durability of this form of intervention are largely unknown. The records of five patients who received endografts to treat aortobronchial fistulas at our institution were reviewed. A literature review was also conducted using MEDLINE to identify reports detailing outcomes of patients undergoing thoracic endovascular aortic repair for this condition. Primary outcome end points included intraoperative mortality, 30-day mortality, and aortobronchial fistula recurrence. For the five patients treated at our institution, technical success was 100%. In follow-up, aortobronchial fistulas recurred in two patients, resulting in one patient death and one endograft explantation. We identified 32 reports that met inclusion for our final review. Inclusive of the five patients treated at out institution, 67 patients with reported outcomes comprised the overall analysis. Most patients (55%) had previously undergone thoracic aortic surgery. Commercially manufactured thoracic endografts were used in 75% of patients. No intraoperative mortality was reported, and the 30-day mortality was 1.5%. Aortobronchial fistula recurred after endovascular repair in six patients (9%) through a mean follow-up of 21.5 months. Three cases of recurrent aortobronchial fistula resulted in patient death. Thoracic endovascular aortic repair of aortobronchial fistulas appears to a viable alternative to conventional open repair with excellent short-term results. Recurrence of the aortobronchial fistula after endovascular repair is a potential complication necessitating long-term surveillance. Individual risk assessment is needed to determine if endovascular repair should be used as bridge therapy or as a definitive repair.