Endovascular Stent-Graft Repair of a Pulmonary Artery–Bronchial Fistula

Davison, Brian D.; Ring, David H.; Bueno, Raphael; Jaklitsch, Michael T.

doi:10.1097/01.rvi.0000082825.75926.82

Cited by 15 publications

(12 citation statements)

References 8 publications

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“…Endovascular covered stent placement within the pulmonary artery to exclude the afferent origin of the PAVF is a possible therapeutic approach, as has been reported with pulmonary artery-bronchial fistula. 17 This was not considered as a therapeutic option in our patient because endovascular surgery was very much at its infancy at our institution at the time this patient was being cared for. Additionally, it does appear, except in a small number of published results, that surgical therapy with ligation of the fistula, with or without associated pulmonary resection, offers the best results.…”

Section: Discussionmentioning

confidence: 96%

Posttraumatic Pulmonary Arteriovenous Fistula: Is Resection the Procedure of Choice? A Case Report and Review of Literature

Ploch

Datta

Thompson

et al. 2009

Journal of Trauma: Injury, Infection &Amp; Critical Care

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osttraumatic pulmonary arteriovenous fistula (PAVF) is a rare clinical entity. Most PAVFs are congenital and arise in the setting of hereditary hemorrhagic telangiectasia. Acquired PAVFs are rare and have been reported with metastatic thyroid carcinoma, cirrhosis, pulmonary schistosomiasis, actinomycosis, mitral stenosis, Fanconi's syndrome, and trauma. We present a case of acquired PAVF presenting 1 year after a thoracic stab wound injury with a review of the previously reported cases and a discussion. CASE REPORTThe patient is a 27-year-old male who sustained a single stab wound to the right chest in the para-sternal region. His vital signs were stable on initial evaluation and he reported only shortness of breath. A right chest tube was placed with minimal return of blood. Computed tomography of the chest was performed, which revealed a large unevacuated right hemothorax. A second chest tube was placed, without improvement, based on serial chest films.The patient was taken to the operating room for right posterolateral thoracotomy and evacuation of clotted hemothorax. A large amount of clotted blood was evacuated and active chest wall bleeding was controlled with electrocautery. A pulmonary laceration with an associated 5-cm parenchymal hematoma was identified in the right upper lobe. The segment containing the laceration and the hematoma was resected with a single application of a gastrointestinal anastomosis-stapling device. The patient returned to the operating room the following day for significant, persistent bloody chest tube output and a drop in hematocrit to 18%. A right hemothorax was evacuated, but no site of bleeding was identified. The patient was extubated the following day and discharged to home on postoperative day 6.The patient was lost to follow up during the next several months. He presented to an outlying hospital with complaints of progressive weakness, fatigue, shortness of breath, and several episodes of syncope a year after initial surgery. On physical examination, the patient appeared anxious. Jugular venous distension was not present. The chest was clear to auscultation bilaterally and there was no appreciable murmur heard over the precordium. Resting O 2 saturation on room air was 85% and fell to 75% with exertion. Hemoglobin and hematocrit were 19.0 and 55%, respectively. A small right pleural effusion was noted on chest X-ray film. Computed tomography of the chest showed a mild amount of scarring in the right upper lobe and was negative for pulmonary embolism. A transesophageal echocardiogram was performed with a bubble study and this demonstrated a right to left shunt. A pulmonary angiogram was obtained, which revealed a PAVF with significant flow between the inferior division of the right pulmonary artery and the right superior pulmonary vein ( Figs. 1 and 2). Pulmonary function tests were performed and the FEV 1 (forced expiratory volume in 1 sec) was reported at 2.73 (Ͼ40% predicted value).The interventional radiologist ruled out therapeutic embolization based on the large size ...

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Section: Discussionmentioning

confidence: 96%

Posttraumatic Pulmonary Arteriovenous Fistula: Is Resection the Procedure of Choice? A Case Report and Review of Literature

Ploch

Datta

Thompson

et al. 2009

Journal of Trauma: Injury, Infection &Amp; Critical Care

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“…The fistula may be hidden from view as a result of simultaneously existing consolidation due to atelectasis [6] or ongoing infection such as Aspergillosis [2] . CT Angiography has been described as useful in post lobectomy patients as possibly showing a residual space containing air-fluid level as well as bubbles around the bronchial stump which is highly suspicious for BPAF [8] . Bronchoscopy may also provide valuable diagnostic information if it shows a dark venous blood within the endobronchialtree [9] .…”

Section: Discussionmentioning

confidence: 99%

“…Surgical options such as lobectomy carry a significant risk of mortality (up to 27%), especially in the acute setting [10] . Self expanding covered stents offer an alternative option which may be useful in preserving blood flow to the artery while avoiding a large surgical procedure [8] . In our case, a covered stent was not felt to be feasible given the significant narrowing of the pulmonary artery, unlikely to accommodate the 9-10 French sheath used to deliver the covered stent.…”

Section: Discussionmentioning

confidence: 99%

Massive hemoptysis due to bronchopulmonary arterial fistula successfuly treated with amplatzer plug occlusion

Chehab¹,

Mandava²,

Smillie³

et al. 2014

JBGC

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We present the case of a 59-year-old male with massive hemoptysis secondary to a bronchopulmonary artery fistula formed as the result of a perihilar lung cancer. The hemoptysis was successfully treated by Amplatzer Plug (St. Jude Medical) embolization of the supplying pulmonary artery branch. At the same time, bronchoscopy was performed to tamponade the patients bleeding and avoid exsanguination. Biopsy of the mass demonstrated poorly differentiated non small cell carcinoma. Post procedure day 13 the patient underwent staging with PET CT which showed localized disease. His hemoptysis resolved.

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“…Davidson et al9 reported a case of a pulmonary artery-to-bronchial stump fistula after a right upper lobectomy that was successfully treated with endovascular placement of a covered stent. Management by endovascular stent placement has been primarily used for aortobronchial fistulas related to aneurysms or pseudoaneurysms of the descending thoracic aorta with successful occlusion 10,11,12.…”

Section: Discussionmentioning

confidence: 99%

Fatal Bronchovascular Fistula after a Single Lung Transplantation: A Case Report

Samano

Saka

Caramori

et al. 2009

Clinics

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Endovascular Stent-Graft Repair of a Pulmonary Artery–Bronchial Fistula

Cited by 15 publications

References 8 publications

Posttraumatic Pulmonary Arteriovenous Fistula: Is Resection the Procedure of Choice? A Case Report and Review of Literature

Posttraumatic Pulmonary Arteriovenous Fistula: Is Resection the Procedure of Choice? A Case Report and Review of Literature

Massive hemoptysis due to bronchopulmonary arterial fistula successfuly treated with amplatzer plug occlusion

Fatal Bronchovascular Fistula after a Single Lung Transplantation: A Case Report

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