Melvan John Nicholas, DeLaRosa Jacob, Vasquez Julio C
Division of Cardiothoracic Surgery, Department of Surgery, Emory University, Atlanta, GA.
Division of Cardiothoracic Surgery, Department of Surgery, Emory University, Atlanta, GA; Department of Cardiac and Endovascular Surgery, Portneuf Medical Center, Pocatello, ID.
Ann Vasc Surg. 2017 May;41:283.e1-283.e4. doi: 10.1016/j.avsg.2016.10.040. Epub 2017 Mar 7.
Continued enlargement of the aneurysm sac after thoracic endovascular aortic repair (TEVAR) is a known risk after endovascular treatment of thoracic aortic aneurysms. For this reason, periodic outpatient follow-up is required to identify situations that require repair. Here, we describe an aortobronchial fistula (ABF) in a patient lost to follow-up, that presented 3 years after an elective TEVAR done for a primary, descending thoracic aortic aneurysm. Our patient arrived in extremis and suffered massive hemoptysis leading to her demise. Computed tomography (CT) angiogram near the time of her death demonstrated a bleeding ABF immediately distal to her previous TEVAR repair. Aortic aneurysmal disease remains life threatening even after repair. Improved endovascular techniques and devices have resulted in decreased need for reintervention. However, this case demonstrates the risk of thoracic aortic disease progression and highlights the importance of establishing consistent, long-term follow-up after TEVAR.
胸主动脉腔内修复术（TEVAR）后动脉瘤囊持续增大是胸主动脉瘤腔内治疗后已知的风险。因此，需要定期门诊随访以识别需要修复的情况。在此，我们描述了一例失访患者发生的主动脉支气管瘘（ABF），该患者在因原发性降主动脉瘤接受择期TEVAR治疗3年后出现。我们的患者病情危急，发生大量咯血，最终死亡。她死亡时附近的计算机断层扫描（CT）血管造影显示，在她之前的TEVAR修复部位远端立即有一个出血性ABF。即使在修复后，主动脉瘤疾病仍然危及生命。改进的血管内技术和器械减少了再次干预的必要性。然而，本病例证明了胸主动脉疾病进展的风险，并强调了在TEVAR后建立持续、长期随访的重要性。
