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DOI: 10.1055/s-0031-1297863
TEVAR in aortic erosion – Results of endovascular treatment of aortobronchial and aortoesophageal fistulas and mycotic aneurysm
Objective: Aortic erosions due to aortobronchial (ABF) and aortoesophageal fistulas (AEF) are lifethreatening bleeding complications. We analyzed our results of thoracic endovascular aortic repair (TEVAR) in ABF, AEF and mycotic thoracic aortic aneurysm.
Methods: Between 1995 and 2010, TEVAR (n=12) was performed in10 patients (6 men, mean age 61 years, range 34–77 years) with aortic erosion. Indications were ABF (n=4), AEF (n=4), one aortic erosion due to pleural empyema and one mycotic TAA. In 2 cases(1 ABF, 1 AEF) secondary reintervention (graft extension) was necessary. All patients received repetitve CT-scans during follow-up.
Results: Technical success rate (sealing of lesion) was 100%. The majority of implantations was performed under general anaesthesia (10/12) via femoral access (8/12).
In the ABF-group, 3 patients are alive after 61, 139 and 188 months. One patient died (10 months) of nonrelated cause. In one case, graft extension was necessary for recurrent hemoptysis after 5 months. In the AEF-group, only one patient is alive (8 months). 2 patients died in the early postoperative phase due to recurrent pneumonia/sepsis, another patient died after 7 months due to kachexia. Again, in one case, graft extension was performed after 4 months for recurrent hematemesis. The patient with aortic erosion due to pleural empyema died 7 days postoperatively due to pneumonia/sepsis. The patient with mycotic TAA following lung transplantation is alive and well after 65 months.
Conclusion: Despite small series, TEVAR seems safe and durable in ABF. In AEF, aortic sealing as primary goal of treatment could be achieved. However, survival in the latter is limited by sepsis (pneumonia/mediastinitis) and the underlying malignant disease in these patients. A multicentric study would be desirable to further evaluate this treatment option.