Article
Aortic stent-grafts in aortobronchial fistulas (ABFs)
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Authors
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M. Gawenda
- Schwerpunkt Gefäßchirurgie, Klinikum der Universität zu Köln
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J. Aleksic
- Schwerpunkt Gefäßchirurgie, Klinikum der Universität zu Köln
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M. Zähringer
- Institut für Radiologische Diagnostik, Klinikum der Universität zu Köln
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J. Brunkwall
- Schwerpunkt Gefäßchirurgie, Klinikum der Universität zu Köln
| Published: | June 15, 2005 |
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Outline
Text
Introduction
ABFs are rare but fatal complications following thoracic aortic operations. Open repair carries the risk of high mortality rate. Currently, endoluminal stentgrafting is offered as the preferred method of treatment. According to experimental data, suggesting that stentgrafts are more susceptible to prosthetic infection, this recommendation is dubious.
Materials
In a cohort of 39 patients, treated at our institution between 1999 and 2004 for thoracic aortic pathology with endoluminal stent grafts, 3 patients (2 men; mean age 50 years, range 42-62) presented hemoptysis. The diagnostics confirmed the occurrence of post-surgical ABFs.Additionally, we performed a systematic bibliographic review dealing with the key words "aortobronchial fistula" and "endovascular".
Results
Procedural success was achieved in all patients with ABFs without peri-procedural complications. Clinical success was achieved in 2 patients (follow-up: 27.5 and 50 months). A third patient presented a type-II-endoleak with stable aneurysm diameter. During follow-up (15.5 months) he developed multiple mycotic aneurysms at the visceral and deep femoral arteries (induced by Candida species) requiring surgical intervention.The current literature to August 2004, reviewed 34 cases of ABFs treated endoluminally. Regardless of the high rate of technical success (>90%), the rate of therapy failure (mortality and recurrence of ABFs) during follow-up was quite high (30%).
Discussion
The presented cases and the systemic bibliographic review demonstrated that endoluminal stent grafting is a therapeutic option at ABFs, mainly to control life-threatening hemoptysis. But the susceptibility to prosthetic infection with recurrent ABFs and hemorrhagic episodes indicate that endoluminal stent grafting is not a long-term solution.
