Stent-graft repair of aortobronchial fistula: a review.

PURPOSE

To evaluate the role of aortic stent-graft implantation in managing aortobronchial fistula (ABF).

METHODS

A search of the Medline, EMBASE, and Cochrane databases for studies reporting on ABF treated with stent-grafts from 1996 to 2008 retrieved 44 articles with data on 82 ABFs. Most (57 ABFs) were published in 30 case reports; the others were retrieved from 14 acute aortic series.

RESULTS

In the perioperative period, 4 (4.9%) deaths (3 from hemorrhage) were reported, but no paraplegia/stroke. Local graft-related complications were more common, including arm ischemia (n = 4) and iliac ruptures (n = 3). Long-term data were available for only a few studies. Recurrent hemorrhage (14%) occurred from 2 weeks to 9 years after repair. Reinterventions to manage recurrences were generally based on redo endografting.

CONCLUSION

A contaminated field and the emergency setting make stent-graft repair of ABFs challenging. After successful stent-graft deployment, the risks of recurrence and mortality are concerning. One can infer from the data that endografting might be a reasonable temporary bridge solution, but potentially unstable in the long term. Open repair likely will remain indicated once the patient has been stabilized physiologically with emergent stent-graft repair.