Aorto-bronchial and aorto-pulmonary fistulation after thoracic endovascular aortic repair: An analysis from the European Registry of Endovascular Aortic Repair Complications

Martin Czerny, Diana Reser, Holger Eggebrecht, Karin Janata, Gottfried Sodeck, Christian Etz, Maximilian Luehr, Fabio Verzini, Diletta Loschi, Roberto Chiesa, Germano Melissano, Andrea Kahlberg, Philippe Amabile, Wolfgang Harringer, Rolf Alexander Janosi, Raimund Erbel, Jürg Schmidli, Piergiorgio Tozzi, Yutaka Okita, Ludovic CanaudAli Khoynezhad, Gabriele Maritati, Piergiorgio Cao, Tilo Kölbel, Santi Trimarchi

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: To learn upon incidence, underlying mechanisms and effectiveness of treatment strategies in patients with central airway and pulmonary parenchymal aorto-bronchial fistulation after thoracic endovascular aortic repair (TEVAR). METHODS: Analysis of an international multicentre registry (European Registry of Endovascular Aortic Repair Complications) between 2001 and 2012 with a total caseload of 4680 TEVAR procedures (14 centres). RESULTS: Twenty-six patients with a median age of 70 years (interquartile range: 60-77) (35% female) were identified. The incidence of either central airway (aorto-bronchial) or pulmonary parenchymal (aorto-pulmonary) fistulation (ABPF) in the entire cohort after TEVAR in the study period was 0.56% (central airway 58%, peripheral parenchymal 42%). Atherosclerotic aneurysm formation was the leading indication for TEVAR in 15 patients (58%). The incidence of primary endoleaks after initial TEVAR was n = 10 (38%), of these 80% were either type I or type III endoleaks. Fourteen patients (54%) developed central left bronchial tree lesions, 11 patients (42%) pulmonary parenchymal lesions and 1 patient (4%) developed a tracheal lesion. The recognized mechanism of ABPF was external compression of the bronchial tree in 13 patients (50%), the majority being due to endoleak formation, further ischaemia due to extensive coverage of bronchial feeding arteries in 3 patients (12%). Inflammation and graft erosion accounted for 4 patients (30%) each. Cumulative survival during the entire study period was 39%. Among deaths, 71% were attributed to ABPF. There was no difference in survival in patients having either central airway or pulmonary parenchymal ABPF (33 vs 45%, log-rank P = 0.55). Survival with a radical surgical approach was significantly better when compared with any other treatment strategy in terms of overall survival (63 vs 32% and 63 vs 21% at 1 and 2 years, respectively), as well as in terms of fistula-related survival (63 vs 43% and 63 vs 43% at 1 and 2 years, respectively). CONCLUSIONS: ABPF is a rare but highly lethal complication after TEVAR. The leading mechanism behind ABPF seems to be a continuing external compression of either the bronchial tree or left upper lobe parenchyma. In this setting, persisting or newly developing endoleak formation seems to play a crucial role. Prognosis does not differ in patients with central airway or pulmonary parenchymal fistulation. Radical bronchial or pulmonary parenchymal repair in combination with stent graft removal and aortic reconstruction seems to be the most durable treatment strategy.

Original languageEnglish
Article numberezu443
Pages (from-to)252-257
Number of pages6
JournalEuropean Journal of Cardio-thoracic Surgery
Volume48
Issue number2
DOIs
Publication statusPublished - Aug 1 2015

Keywords

  • Aorto-bronchial fistulation
  • Complications
  • Thoracic endovascular aortic repair
  • Treatment

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Fingerprint Dive into the research topics of 'Aorto-bronchial and aorto-pulmonary fistulation after thoracic endovascular aortic repair: An analysis from the European Registry of Endovascular Aortic Repair Complications'. Together they form a unique fingerprint.

  • Cite this

    Czerny, M., Reser, D., Eggebrecht, H., Janata, K., Sodeck, G., Etz, C., Luehr, M., Verzini, F., Loschi, D., Chiesa, R., Melissano, G., Kahlberg, A., Amabile, P., Harringer, W., Janosi, R. A., Erbel, R., Schmidli, J., Tozzi, P., Okita, Y., ... Trimarchi, S. (2015). Aorto-bronchial and aorto-pulmonary fistulation after thoracic endovascular aortic repair: An analysis from the European Registry of Endovascular Aortic Repair Complications. European Journal of Cardio-thoracic Surgery, 48(2), 252-257. [ezu443]. https://doi.org/10.1093/ejcts/ezu443