Strategies for Endovascular Aortic Repair in Aortobronchial and Aortoesophageal Fistulas

Abstract

Objective To report our experience of thoracic endovascular aortic repair (TEVAR) for acute bleeding originating from the thoracic aorta in patients with aortobronchial fistula (ABF) or aortoesophageal fistula (AEF).

Patients and Methods A total of nine patients (three woman) were treated from September 1995 to March 2012 by TEVAR for ABF (n = 5) and AEF (n = 4). The implants (N = 14) were introduced with fluoroscopic guidance via the aorta (n = 1), the iliac (n = 2), or femoral (n = 11) artery, respectively.

Results All aortic lesions could be sealed successfully. Perioperative morbidity was 0% in the ABF group and 50% (2 of 4) in the AEF group and no procedure-related morbidity was noted except one patient who received aortofemoral reconstruction because of iliac occlusive disease. After an overall mean follow-up of 56 months, three patients of the ABF group are alive and well and two patients died of nonrelated cause. Of the AEF group, one patient is alive after 22 months, and one died from metastasized esophageal cancer after 7 months.

Conclusion TEVAR is a safe and reliable procedure in the management of ABF. For AEF, TEVAR provides a successful first-line treatment to seal the fistula and control bleeding. However, prognosis is limited by the esophageal lesion and by ongoing mediastinitis/sepsis.

Keywords

descending aorta - aortobronchial fistula - aortoesophageal fistula - endovascular repair

• References

• 1 Topel I, Stehr A, Steinbauer MG, Piso P, Schlitt HJ, Kasprzak PM. Surgical strategy in aortoesophageal fistulae: endovascular stentgrafts and in situ repair of the aorta with cryopreserved homografts. Ann Surg 2007; 246 (5) 853-859
• 2 Cheng D, Martin J, Shennib H , et al. Endovascular aortic repair versus open surgical repair for descending thoracic aortic disease a systematic review and meta-analysis of comparative studies. J Am Coll Cardiol 2010; 55 (10) 986-1001
• 3 Favre JP, Gournier JP, Adham M, Rosset E, Barral X. Aortobronchial fistula: report of three cases and review of the literature. Surgery 1994; 115 (2) 264-270
• 4 Kieffer E, Chiche L, Gomes D. Aortoesophageal fistula: value of in situ aortic allograft replacement. Ann Surg 2003; 238 (2) 283-290
• 5 Dake MD, Miller DC, Semba CP, Mitchell RS, Walker PJ, Liddell RP. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med 1994; 331 (26) 1729-1734
• 6 Hiratzka LF, Bakris GL, Beckman JA , et al. M. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease. Circulation 2010; 121: e266-e369
• 7 Pitton MB, Duber C, Neufang A, Schlegel J. Endovascular repair of a non-contained aortic rupture caused by a penetrating aortic ulcer. Cardiovasc Intervent Radiol 2002; 25 (1) 64-67
• 8 Verhoeven EL, Vourliotakis G. Thoracic endovascular aortic repair for aortobronchial or aortoesophageal fistulas: permanent or temporary salvage or not an option at all?. J Endovasc Ther 2009; 16 (4) 441-442
• 9 Campagna AC, Wehner JH, Kirsch CM , et al. Endovascular stenting of an aortopulmonary fistula presenting with hemoptysis. A case report. J Cardiovasc Surg (Torino) 1996; 37 (6) 643-646
• 10 Chuter TAM, Ivancev K, Lindblad B, Brunkwall J, Arén C, Risberg B. Endovascular stent-graft exclusion of an aortobronchial fistula. J Vasc Interv Radiol 1996; 7 (3) 357-359
• 11 Jonker FH, Schlösser FJ, Moll FL , et al. Outcomes of thoracic endovascular aortic repair for aortobronchial and aortoesophageal fistulas. J Endovasc Ther 2009; 16 (4) 428-440
• 12 Chiesa R, Melissano G, Marone EM, Kahlberg A, Marrocco-Trischitta MM, Tshomba Y. Endovascular treatment of aortoesophageal and aortobronchial fistulae. J Vasc Surg 2010; 51 (5) 1195-1202
• 13 Riesenman PJ, Brooks JD, Farber MA. Thoracic endovascular aortic repair of aortobronchial fistulas. J Vasc Surg 2009; 50 (5) 992-998
• 14 De Rango P, Estrera AL, Azizzadeh A, Safi HJ. Stent-graft repair of aortobronchial fistula: a review. J Endovasc Ther 2009; 16 (6) 721-732
• 15 Bailey CJ, Force S, Milner R, Kasirajan K, Veeraswamy RK. Thoracic endovascular repair as a safe management strategy for aortobronchial fistulas. J Vasc Surg 2011; 53 (5) 1202-1209 , discussion 1209
• 16 Dorweiler B, Dueber C, Neufang A, Schmiedt W, Pitton MB, Oelert H. Endovascular treatment of acute bleeding complications in traumatic aortic rupture and aortobronchial fistula. Eur J Cardiothorac Surg 2001; 19 (6) 739-745
• 17 Pitton MB, Herber S, Schmiedt W, Neufang A, Dorweiler B, Düber C. Long-term follow-up after endovascular treatment of acute aortic emergencies. Cardiovasc Intervent Radiol 2008; 31 (1) 23-35
• 18 Oliva VL, Bui BT, Leclerc G , et al. Aortoesophageal fistula: repair with transluminal placement of a thoracic aortic stent-graft. J Vasc Interv Radiol 1997; 8 (1 Pt 1) 35-38
• 19 Allen RC, Sebastian MG. The role of endovascular techniques in aortoesophageal fistula repair. J Endovasc Ther 2001; 8 (6) 602-603
• 20 Feezor RJ, Hess PJ, Lee WA. Endovascular treatment of a malignant aortoesophageal fistula. J Vasc Surg 2009; 49 (3) 778
• 21 Böckler D, Schumacher H, Schwarzbach M, Ockert S, Rotert H, Allenberg JR. Endoluminal stent-graft repair of aortobronchial fistulas: bridging or definitive long-term solution?. J Endovasc Ther 2004; 11 (1) 41-48
• 22 Czerny M, von Allmen R, Opfermann P , et al. Self-made pericardial tube graft: a new surgical concept for treatment of graft infections after thoracic and abdominal aortic procedures. Ann Thorac Surg 2011; 92 (5) 1657-1662