Pseudoaneurysm and aortobronchial fistula after surgical bypass for aorticcoarctation: Management with endovascular stent-graft

Purpose: To report the endovascular repair of an aortobronchial fistula at the distal anastomosis of a complex thoracic graft. Case Report. A 61-year-old man operated 18 years prior for aortic coarctati on presented with hemoptysis. An aortobronchial fistula was suspected, but spiral computed tomography and angiography showed only a small pseudoaneury sm at the distal anastomosis without revealing the fistulous tract. A Talen t stent-graft was successfully deployed through a femoral access, but the l arge delivery system injured the external iliac artery, producing a retrope ritoneal hemorrhage. Prompt balloon occlusion of the aorta and subsequent b ypass graft repair of the arterial injury prevented serious sequelae. The p atient recovered without further complications. Follow-up imaging to 2 year s has documented exclusion of the pseudoaneurysm with no hemoptysis or sign s of new false aneurysm formation. Conclusions: Endovascular exclusion of anastomotic pseudoaneurysms even in complicated cases can be an efficient treatment option, but the procedure m ust be carefully planned and executed in order to achieve good results.