Two Cases of Thoracic Endovascular Repair for Aortobronchial Fistula Due to Diseases of the Descending Thoracic Aorta

Abstract

Aortobronchial fistula (ABF) is a rare condition that can be fatal if left untreated. Despite improvements in surgical techniques, conventional open repair still has a high operative morbidity and mortality. Recently, successful treatment of ABF using thoracic endovascular aortic repair (TEVAR) was reported. We present two cases of ABF with descending thoracic aortic disease. Case 1 was that of an 81-year-old man who presented to the emergency department with hemoptysis. He had undergone graft replacement for treatment of a thoracic aortic aneurysm. Computed tomography (CT) revealed a descending thoracic aortic aneurysm infiltrating the adjacent lung parenchyma. Case 2 was that of a 78-year-old man who was admitted to our institution with complaints of hemoptysis. CT revealed a penetrating atherosclerotic ulcer of the descending thoracic aorta and periaortic hematoma adhering to the left bronchial tree. In both cases, TEVAR was successfully performed, with an uneventful postoperative course. Both patients continued receiving antibiotics. C-reactive protein levels remained within normal limit, and postoperative CT demonstrated accurate placement of the endografts with no endoleaks, reduced infiltration in the lung parenchyma, and no evidence of endograft infection. Despite the potential risks of ABF recurrence and endograft infection, TEVAR can be a good, life-saving option for patients with ABF accompanied by descending thoracic aortic disease.