Aortobronchial fistula is a rare but frequently lethal cause of hemoptysis. The most common causes are expanding descending thoracic aortic aneurysm, previous aortic surgery or neoplasm.
We present a case of a 60 year-old gentleman who, in 1960, had a left lower lobectomy for extensive bronchiectasis. Multiple, recurrent pneumonias of his remaining left lung resulted in bronchomalacia and chronic collapse of his left upper lobe. The bronchomalacia was treated with endoluminal bronchial nitinol stents because of his inability to tolerate any further resection secondary to his medical comorbidities. Approximately 2 years after the stent placement, he developed hemoptysis. Initial bronchoscopy revealed granulation tissue at the distal end of the stents. With the idea that the granulation tissue was the cause of his hemoptysis laser and PDT therapy were attempted without success. Bronchial artery embolization was then considered; on the initial aortogram an aortobronchial fistula was identified. Because of his poor overall medical condition and inability to tolerate an operation an endovascular stent graft was placed across the fistula with subsequent successful resolution of his hemoptysis.
Although aneurysmal disease, previous aortic surgery and neoplasm are the most common causes of aortobronchial fistula, other causes exist as well. In our patient the chronic inflammation from the in dwelling endobronchial stents as well as the bronchomalacia from recurrent infections predisposed him to fistulazation. Formal graft repair of the aorta with or without pulmonary resection is the classic treatment. Most patients with this condition are too high risk for such an extensive procedure. Although there is risk of infection, endovascular exclusion of the fistula provides a safe and effective alternitive for high risk patients.
Aortobronchial fistula can be successfully treated with less invasive, endovascular techniques in high risk patients.
G.G. Smaroff, None.