AB032. Successful treatment of massive hemoptysis with endovascular stenting in patient with aortobronchial fistula and history of operated thoracic aortic dissection

Abstract: Male patient, 61 years old, non-smoker, with recurrent episodes of massive haemoptysis, during the last three months, comes for further investigation and treatment. He has history of open-chest surgery to treat a thoracic dissection type B, by implanting a 10 cm length and 24 mm diameter, graft, right after the exact point the left subclavian artery arises. Chest X-ray was normal and the patient was free of symptoms the last ten days. He had already undergone a chest CT scan, that designated the presence of pseudoaneurysm at the peripheral anastomosis, and a bronchoscopy, that designated the source of haemorrhage from the left upper lobe bronchus. Also, he had undergone through embolism of the left bronchial arteries and thyrocervical branch, with temporary remission of haemoptysis. Aortobronchial fistula was suspected and endovascular repair of the pseudoaneurysm was immediately performed, using a tube graft, 10 cm length and 28 mm diameter. The patient was discharged the fourth postoperative day, symptom free. During the next year follow ups, no haemoptysis was observed, while since the first month, the pseudoaneurysm had already gone from post-op CT scan images. Haemoptysis in patients with prior history of open-chest surgery of the thoracic aorta and presence of pseudoaneurysm, immediately sets reasonable suspicion of aortobronchial fistula, a life threatening complication, even after years from surgery. Endovascular repair seems to be a safe and less invasive treatment, with good short- and midterm results.

Keywords: Massive hemoptysis; aortobronchial fistula; pseudoaneurysm