Riesenman Paul J, Brooks James D, Farber Mark A
Department of Surgery, Division of Vascular Surgery, University of North Carolina, Chapel Hill, NC 27599-7212, USA.
J Vasc Surg. 2009 Nov;50(5):992-8. doi: 10.1016/j.jvs.2009.03.001. Epub 2009 Jul 26.
Thoracic endovascular aortic repair of aortobronchial fistulas is an emerging treatment modality for this highly lethal condition. The feasibility and long-term durability of this form of intervention are largely unknown.
The records of five patients who received endografts to treat aortobronchial fistulas at our institution were reviewed. A literature review was also conducted using MEDLINE to identify reports detailing outcomes of patients undergoing thoracic endovascular aortic repair for this condition. Primary outcome end points included intraoperative mortality, 30-day mortality, and aortobronchial fistula recurrence.
For the five patients treated at our institution, technical success was 100%. In follow-up, aortobronchial fistulas recurred in two patients, resulting in one patient death and one endograft explantation. We identified 32 reports that met inclusion for our final review. Inclusive of the five patients treated at out institution, 67 patients with reported outcomes comprised the overall analysis. Most patients (55%) had previously undergone thoracic aortic surgery. Commercially manufactured thoracic endografts were used in 75% of patients. No intraoperative mortality was reported, and the 30-day mortality was 1.5%. Aortobronchial fistula recurred after endovascular repair in six patients (9%) through a mean follow-up of 21.5 months. Three cases of recurrent aortobronchial fistula resulted in patient death.
Thoracic endovascular aortic repair of aortobronchial fistulas appears to a viable alternative to conventional open repair with excellent short-term results. Recurrence of the aortobronchial fistula after endovascular repair is a potential complication necessitating long-term surveillance. Individual risk assessment is needed to determine if endovascular repair should be used as bridge therapy or as a definitive repair.
胸主动脉腔内修复术治疗主动脉支气管瘘是这种高致死性疾病的一种新兴治疗方式。这种干预形式的可行性和长期耐久性在很大程度上尚不清楚。
回顾了在我们机构接受腔内移植物治疗主动脉支气管瘘的5例患者的记录。还使用MEDLINE进行了文献综述，以确定详细描述接受胸主动脉腔内修复术治疗该疾病患者结局的报告。主要结局终点包括术中死亡率、30天死亡率和主动脉支气管瘘复发。
在我们机构治疗的5例患者中，技术成功率为100%。在随访中，2例患者出现主动脉支气管瘘复发，导致1例患者死亡和1例腔内移植物取出。我们确定了32篇符合最终综述纳入标准的报告。包括在我们机构治疗的5例患者在内，共有67例有报告结局的患者纳入总体分析。大多数患者（55%）此前接受过胸主动脉手术。75%的患者使用了商业制造的胸主动脉腔内移植物。未报告术中死亡，30天死亡率为1.5%。在平均21.5个月的随访中，6例患者（9%）在血管腔内修复后出现主动脉支气管瘘复发。3例复发性主动脉支气管瘘导致患者死亡。
胸主动脉腔内修复术治疗主动脉支气管瘘似乎是传统开放修复术的一种可行替代方法，短期效果良好。血管腔内修复术后主动脉支气管瘘复发是一种潜在并发症，需要长期监测。需要进行个体风险评估，以确定血管腔内修复术应作为桥接治疗还是确定性修复。
