Who needs their descending thoracic aorta anyway? Extra-anatomic bypass for aorto-bronchial fistula after TEVAR
Abstract Background Aortobronchial fistula after TEVAR remains a vexing clinical problem associated with high mortality. Although a combination of endovascular and open surgical strategies have been reported in managing this pathology, there is as yet no definitive treatment algorithm that can be us...
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| Format: | Article |
| Language: | English |
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BMC
2023-08-01
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| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13019-023-02326-x |
| _version_ | 1797556524966477824 |
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| author | Joshua S. Newman Stevan S. Pupovac S. Jacob Scheinerman Jui-Chuan Tseng Jonathan M. Hemli Derek R. Brinster |
| author_facet | Joshua S. Newman Stevan S. Pupovac S. Jacob Scheinerman Jui-Chuan Tseng Jonathan M. Hemli Derek R. Brinster |
| author_sort | Joshua S. Newman |
| collection | DOAJ |
| description | Abstract Background Aortobronchial fistula after TEVAR remains a vexing clinical problem associated with high mortality. Although a combination of endovascular and open surgical strategies have been reported in managing this pathology, there is as yet no definitive treatment algorithm that can be used for all patients. We discuss our approach to an aortobronchial fistula associated with an overtly infected aortic endograft. Case presentation A 49-year-old female sustained a traumatic aortic transection 14 years prior, managed by an endovascular stent-graft. Due to persistent endoleak, she underwent open replacement of her descending thoracic aorta 4 years later. Ten years after her open aortic surgery, the patient presented with hemoptysis, and a pseudoaneurysm at her distal aortic suture line was identified on computed tomography, whereupon she underwent placement of an endograft. Eight weeks later, she presented with dyspnea, recurrent hemoptysis, malaise and fever, with clinical and radiographic evidence of an aortobronchial communication and an infected aortic stent-graft. The patient underwent management via a two-stage open surgical approach, constituting an extra-anatomic bypass from her ascending aorta to distal descending aorta and subsequent radical excision of her descending aorta with all associated infected prosthetic material and repair of the airway. Conclusion Aortobronchial fistula after TEVAR represents a challenging complex clinical scenario. Extra-anatomic aortic bypass followed by radical debridement of all contaminated tissue may provide the best option for durable longer-term outcomes. |
| first_indexed | 2024-03-10T17:04:08Z |
| format | Article |
| id | doaj.art-a2ea777c5bad4d69b154f09f93fa5116 |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-03-10T17:04:08Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-a2ea777c5bad4d69b154f09f93fa51162023-11-20T10:52:57ZengBMCJournal of Cardiothoracic Surgery1749-80902023-08-011811510.1186/s13019-023-02326-xWho needs their descending thoracic aorta anyway? Extra-anatomic bypass for aorto-bronchial fistula after TEVARJoshua S. Newman0Stevan S. Pupovac1S. Jacob Scheinerman2Jui-Chuan Tseng3Jonathan M. Hemli4Derek R. Brinster5Department of Cardiovascular and Thoracic Surgery, North Shore University Hospital, Northwell HealthDepartment of Cardiovascular and Thoracic Surgery, North Shore University Hospital, Northwell HealthDepartment of Cardiovascular and Thoracic Surgery, Lenox Hill Hospital, Northwell HealthDepartment of Cardiovascular and Thoracic Surgery, Lenox Hill Hospital, Northwell HealthDepartment of Cardiovascular and Thoracic Surgery, Lenox Hill Hospital, Northwell HealthDepartment of Cardiovascular and Thoracic Surgery, Lenox Hill Hospital, Northwell HealthAbstract Background Aortobronchial fistula after TEVAR remains a vexing clinical problem associated with high mortality. Although a combination of endovascular and open surgical strategies have been reported in managing this pathology, there is as yet no definitive treatment algorithm that can be used for all patients. We discuss our approach to an aortobronchial fistula associated with an overtly infected aortic endograft. Case presentation A 49-year-old female sustained a traumatic aortic transection 14 years prior, managed by an endovascular stent-graft. Due to persistent endoleak, she underwent open replacement of her descending thoracic aorta 4 years later. Ten years after her open aortic surgery, the patient presented with hemoptysis, and a pseudoaneurysm at her distal aortic suture line was identified on computed tomography, whereupon she underwent placement of an endograft. Eight weeks later, she presented with dyspnea, recurrent hemoptysis, malaise and fever, with clinical and radiographic evidence of an aortobronchial communication and an infected aortic stent-graft. The patient underwent management via a two-stage open surgical approach, constituting an extra-anatomic bypass from her ascending aorta to distal descending aorta and subsequent radical excision of her descending aorta with all associated infected prosthetic material and repair of the airway. Conclusion Aortobronchial fistula after TEVAR represents a challenging complex clinical scenario. Extra-anatomic aortic bypass followed by radical debridement of all contaminated tissue may provide the best option for durable longer-term outcomes.https://doi.org/10.1186/s13019-023-02326-xAortobronchial fistulaTEVARHemoptysisExtra-anatomicDescending thoracic aorta |
| spellingShingle | Joshua S. Newman Stevan S. Pupovac S. Jacob Scheinerman Jui-Chuan Tseng Jonathan M. Hemli Derek R. Brinster Who needs their descending thoracic aorta anyway? Extra-anatomic bypass for aorto-bronchial fistula after TEVAR Journal of Cardiothoracic Surgery Aortobronchial fistula TEVAR Hemoptysis Extra-anatomic Descending thoracic aorta |
| title | Who needs their descending thoracic aorta anyway? Extra-anatomic bypass for aorto-bronchial fistula after TEVAR |
| title_full | Who needs their descending thoracic aorta anyway? Extra-anatomic bypass for aorto-bronchial fistula after TEVAR |
| title_fullStr | Who needs their descending thoracic aorta anyway? Extra-anatomic bypass for aorto-bronchial fistula after TEVAR |
| title_full_unstemmed | Who needs their descending thoracic aorta anyway? Extra-anatomic bypass for aorto-bronchial fistula after TEVAR |
| title_short | Who needs their descending thoracic aorta anyway? Extra-anatomic bypass for aorto-bronchial fistula after TEVAR |
| title_sort | who needs their descending thoracic aorta anyway extra anatomic bypass for aorto bronchial fistula after tevar |
| topic | Aortobronchial fistula TEVAR Hemoptysis Extra-anatomic Descending thoracic aorta |
| url | https://doi.org/10.1186/s13019-023-02326-x |
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