Aorto-bronchial and aorto-pulmonary fistulation after thoracic endovascular aortic repair: an analysis from the European Registry of Endovascular Aortic Repair Complications
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Aorto-bronchial and aorto-pulmonary fistulation after thoracic endovascular aortic repair: an analysis from the European Registry of Endovascular Aortic Repair Complications. / Czerny, Martin; Reser, Diana; Eggebrecht, Holger; Janata, Karin; Sodeck, Gottfried; Etz, Christian; Luehr, Maximilian; Verzini, Fabio; Loschi, Diletta; Chiesa, Roberto; Melissano, Germano; Kahlberg, Andrea; Amabile, Philippe; Harringer, Wolfgang; Janosi, Rolf Alexander; Erbel, Raimund; Schmidli, Jürg; Tozzi, Piergiorgio; Okita, Yutaka; Canaud, Ludovic; Khoynezhad, Ali; Maritati, Gabriele; Cao, Piergiorgio; Kölbel, Tilo; Trimarchi, Santi.
In: EUR J CARDIO-THORAC, Vol. 48, No. 2, 08.2015, p. 252-257.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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T1 - Aorto-bronchial and aorto-pulmonary fistulation after thoracic endovascular aortic repair: an analysis from the European Registry of Endovascular Aortic Repair Complications
AU - Czerny, Martin
AU - Reser, Diana
AU - Eggebrecht, Holger
AU - Janata, Karin
AU - Sodeck, Gottfried
AU - Etz, Christian
AU - Luehr, Maximilian
AU - Verzini, Fabio
AU - Loschi, Diletta
AU - Chiesa, Roberto
AU - Melissano, Germano
AU - Kahlberg, Andrea
AU - Amabile, Philippe
AU - Harringer, Wolfgang
AU - Janosi, Rolf Alexander
AU - Erbel, Raimund
AU - Schmidli, Jürg
AU - Tozzi, Piergiorgio
AU - Okita, Yutaka
AU - Canaud, Ludovic
AU - Khoynezhad, Ali
AU - Maritati, Gabriele
AU - Cao, Piergiorgio
AU - Kölbel, Tilo
AU - Trimarchi, Santi
N1 - © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
PY - 2015/8
Y1 - 2015/8
N2 - 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.
AB - 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.
KW - Aged
KW - Aorta, Thoracic/surgery
KW - Aortic Aneurysm, Thoracic/epidemiology
KW - Aortic Diseases/diagnosis
KW - Blood Vessel Prosthesis Implantation/adverse effects
KW - Bronchial Fistula/diagnosis
KW - Endovascular Procedures/adverse effects
KW - Europe/epidemiology
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Incidence
KW - Lung Diseases/diagnosis
KW - Male
KW - Middle Aged
KW - Prevalence
KW - Registries
KW - Respiratory Tract Fistula/diagnosis
KW - Treatment Outcome
KW - Vascular Fistula/diagnosis
U2 - 10.1093/ejcts/ezu443
DO - 10.1093/ejcts/ezu443
M3 - SCORING: Journal article
C2 - 25414427
VL - 48
SP - 252
EP - 257
JO - EUR J CARDIO-THORAC
JF - EUR J CARDIO-THORAC
SN - 1010-7940
IS - 2
ER -