Aorto-bronchial and aorto-pulmonary fistulation after thoracic endovascular aortic repair: an analysis from the European Registry of Endovascular Aortic Repair Complications

Autor:	Raimund Erbel, Fabio Verzini, Gottfried Sodeck, Philippe Amabile, Yutaka Okita, Andrea Kahlberg, Holger Eggebrecht, Christian D. Etz, Germano Melissano, Diana Reser, Ludovic Canaud, Wolfgang Harringer, Tilo Kölbel, Roberto Chiesa, Piergiorgio Cao, Karin Janata, Rolf Alexander Jánosi, Martin Czerny, Diletta Loschi, Ali Khoynezhad, Jürg Schmidli, Gabriele Maritati, Piergiorgio Tozzi, Santi Trimarchi, Maximilian Luehr
Přispěvatelé:	Czerny, M, Reser, D, Eggebrecht, H, Janata, K, Sodeck, G, Etz, C, Luehr, M, Verzini, F, Loschi, D, Chiesa, Roberto, Melissano, Germano, Kahlberg, ANDREA LUITZ, Amabile, P, Harringer, W, Janosi, Ra, Erbel, R, Schmidli, J, Tozzi, P, Okita, Y, Canaud, L, Khoynezhad, A, Maritati, G, Cao, P, Kolbel, T, Trimarchi, S., University of Zurich, Czerny, Martin
Rok vydání:	2015
Předmět:	Lung Diseases Male Complications Aorto-bronchial fistulation Medizin Aorta Thoracic Aortic aneurysm Interquartile range Prevalence Registries 610 Medicine & health DISSECTION Vascular Fistula TEVAR Incidence Incidence (epidemiology) Endovascular Procedures Treatment AORTOESOPHAGEAL General Medicine Middle Aged 2746 Surgery Europe Dissection INSIGHTS Treatment Outcome Cardiothoracic surgery Cohort Female Radiology medicine.symptom Cardiology and Cardiovascular Medicine Pulmonary and Respiratory Medicine medicine.medical_specialty Thoracic endovascular aortic repair MECHANISMS GRAFT Aortic Diseases 2705 Cardiology and Cardiovascular Medicine Lesion Blood Vessel Prosthesis Implantation medicine.artery medicine Humans Aged Aorta Thoracic/surgery Aortic Aneurysm Thoracic/epidemiology Aortic Aneurysm Thoracic/surgery Aortic Diseases/diagnosis Aortic Diseases/epidemiology Blood Vessel Prosthesis Implantation/adverse effects Blood Vessel Prosthesis Implantation/methods Bronchial Fistula/diagnosis Bronchial Fistula/epidemiology Endovascular Procedures/adverse effects Europe/epidemiology Follow-Up Studies Lung Diseases/diagnosis Lung Diseases/epidemiology Respiratory Tract Fistula/diagnosis Respiratory Tract Fistula/epidemiology Vascular Fistula/diagnosis Vascular Fistula/epidemiology Aorta Aortic Aneurysm Thoracic business.industry medicine.disease 10020 Clinic for Cardiac Surgery Surgery 2740 Pulmonary and Respiratory Medicine Bronchial Fistula Respiratory Tract Fistula business
Zdroj:	Czerny, Martin; Reser, Diana; Eggebrecht, Holger; Janata, Karin; Sodeck, Gottfried; Etz, Christian; Luehr, Maximilian; Verzini, Fabio; Loschi, Diletta; Chiesa, Roberto; Melissano, Germano; Kahlberg, Andrea; Amabile, Philippe; Harringer, Wolfgang; Janosi, Rolf Alexander; Erbel, Raimund; Schmidli, Jürg; Tozzi, Piergiorgio; Okita, Yutaka; Canaud, Ludovic; ... (2015). Aorto-bronchial and aorto-pulmonary fistulation after thoracic endovascular aortic repair: an analysis from the European Registry of Endovascular Aortic Repair Complications. European journal of cardio-thoracic surgery, 48(2), pp. 252-257. Oxford University Press 10.1093/ejcts/ezu443 European Journal of Cardio-thoracic Surgery : Official Journal of the European Association For Cardio-thoracic Surgery, vol. 48, no. 2, pp. 252-257
DOI:	10.1093/ejcts/ezu443
Popis:	OBJECTIVES: To learn upon incidence, underlying mechanisms and effectiveness of treatment strategies in patients with central airway and pulmonary parenchymal aorto-bronchial fistulation after thoracic endovascular aortic repair (TEVAR). METHODS: Analysis of an international multicentre registry (European Registry of Endovascular Aortic Repair Complications) between 2001 and 2012 with a total caseload of 4680 TEVAR procedures (14 centres). RESULTS: Twenty-six patients with a median age of 70 years (interquartile range: 60-77) (35% female) were identified. The incidence of either central airway (aorto-bronchial) or pulmonary parenchymal (aorto-pulmonary) fistulation (ABPF) in the entire cohort after TEVAR in the study period was 0.56% (central airway 58%, peripheral parenchymal 42%). Atherosclerotic aneurysm formation was the leading indication for TEVAR in 15 patients (58%). The incidence of primary endoleaks after initial TEVAR was n = 10 (38%), of these 80% were either type I or type III endoleaks. Fourteen patients (54%) developed central left bronchial tree lesions, 11 patients (42%) pulmonary parenchymal lesions and 1 patient (4%) developed a tracheal lesion. The recognized mechanism of ABPF was external compression of the bronchial tree in 13 patients (50%), the majority being due to endoleak formation, further ischaemia due to extensive coverage of bronchial feeding arteries in 3 patients (12%). Inflammation and graft erosion accounted for 4 patients (30%) each. Cumulative survival during the entire study period was 39%. Among deaths, 71% were attributed to ABPF. There was no difference in survival in patients having either central airway or pulmonary parenchymal ABPF (33 vs 45%, log-rank P = 0.55). Survival with a radical surgical approach was significantly better when compared with any other treatment strategy in terms of overall survival (63 vs 32% and 63 vs 21% at 1 and 2 years, respectively), as well as in terms of fistula-related survival (63 vs 43% and 63 vs 43% at 1 and 2 years, respectively). CONCLUSIONS: ABPF is a rare but highly lethal complication after TEVAR. The leading mechanism behind ABPF seems to be a continuing external compression of either the bronchial tree or left upper lobe parenchyma. In this setting, persisting or newly developing endoleak formation seems to play a crucial role. Prognosis does not differ in patients with central airway or pulmonary parenchymal fistulation. Radical bronchial or pulmonary parenchymal repair in combination with stent graft removal and aortic reconstruction seems to be the most durable treatment strategy. OBJECTIVES: To learn upon incidence, underlying mechanisms and effectiveness of treatment strategies in patients with central airway and pulmonary parenchymal aorto-bronchial fistulation after thoracic endovascular aortic repair (TEVAR). METHODS: Analysis of an international multicentre registry (European Registry of Endovascular Aortic Repair Complications) between 2001 and 2012 with a total caseload of 4680 TEVAR procedures (14 centres). RESULTS: Twenty-six patients with a median age of 70 years (interquartile range: 60-77) (35% female) were identified. The incidence of either central airway (aorto-bronchial) or pulmonary parenchymal (aorto-pulmonary) fistulation (ABPF) in the entire cohort after TEVAR in the study period was 0.56% (central airway 58%, peripheral parenchymal 42%). Atherosclerotic aneurysm formation was the leading indication for TEVAR in 15 patients (58%). The incidence of primary endoleaks after initial TEVAR was n = 10 (38%), of these 80% were either type I or type III endoleaks. Fourteen patients (54%) developed central left bronchial tree lesions, 11 patients (42%) pulmonary parenchymal lesions and 1 patient (4%) developed a tracheal lesion. The recognized mechanism of ABPF was external compression of the bronchial tree in 13 patients (50%), the majority being due to endoleak formation, further ischaemia due to extensive coverage of bronchial feeding arteries in 3 patients (12%). Inflammation and graft erosion accounted for 4 patients (30%) each. Cumulative survival during the entire study period was 39%. Among deaths, 71% were attributed to ABPF. There was no difference in survival in patients having either central airway or pulmonary parenchymal ABPF (33 vs 45%, log-rank P = 0.55). Survival with a radical surgical approach was significantly better when compared with any other treatment strategy in terms of overall survival (63 vs 32% and 63 vs 21% at 1 and 2 years, respectively), as well as in terms of fistula-related survival (63 vs 43% and 63 vs 43% at 1 and 2 years, respectively). CONCLUSIONS: ABPF is a rare but highly lethal complication after TEVAR. The leading mechanism behind ABPF seems to be a continuing external compression of either the bronchial tree or left upper lobe parenchyma. In this setting, persisting or newly developing endoleak formation seems to play a crucial role. Prognosis does not differ in patients with central airway or pulmonary parenchymal fistulation. Radical bronchial or pulmonary parenchymal repair in combination with stent graft removal and aortic reconstruction seems to be the most durable treatment strategy.
Databáze:	OpenAIRE
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