Lee Sun-Geun, Lee Seung Hyong, Park Won Kyoun, Kim Dae Hyun, Song Jae Won, Cho Sang-Ho
Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea.
J Chest Surg. 2021 Oct 5;54(5):425-428. doi: 10.5090/jcs.20.138.
Aortobronchial fistula (ABF) induced by an infected pseudoaneurysm of the thoracic aorta is a life-threatening condition. As surgical treatment is associated with significant mortality and morbidity, thoracic endovascular aneurysm repair (TEVAR) may be an alternative for the treatment of ABF. However, the long-term durability of this intervention is largely unknown and the recurrence of ABF is a potential complication. We experienced a case of recurrent ABF after stent grafting as an early procedure for an infected pseudoaneurysm of the thoracic aorta. Remnant ABF, bronchial and/or aortic wall erosion, vasa vasorum connected with ABF, and recurrent local inflammation of the thin aortic wall around ABF might cause recurrent hemoptysis. As a result, we suggest that TEVAR should be considered as a bridge therapy for the initial treatment of ABF resulting from an infected pseudoaneurysm, and that several options, such as second-stage surgery, should be considered to prevent the recurrence of ABF.
由胸主动脉感染性假性动脉瘤引起的主动脉支气管瘘（ABF）是一种危及生命的疾病。由于手术治疗伴随着显著的死亡率和发病率，胸主动脉腔内修复术（TEVAR）可能是治疗ABF的一种替代方法。然而，这种干预措施的长期耐久性很大程度上未知，且ABF复发是一种潜在并发症。我们遇到一例在作为胸主动脉感染性假性动脉瘤的早期治疗进行支架植入术后ABF复发的病例。残留的ABF、支气管和/或主动脉壁侵蚀、与ABF相连的滋养血管以及ABF周围薄主动脉壁的复发性局部炎症可能导致反复咯血。因此，我们建议TEVAR应被视为因感染性假性动脉瘤导致的ABF初始治疗的桥梁治疗方法，并且应考虑多种选择，如二期手术，以预防ABF复发。
