Outcomes of thoracic endovascular aortic repair for aortobronchial and aortoesophageal fistulas

Purpose: To identify in-hospital and follow-up outcomes of thoracic endovascular aortic repair (TEVAR) for aortobronchial fistula (ABF) and aortoesophageal fistula (AEF). Methods: The authors reviewed all published cases of ABF and AEF undergoing TEVAR indexed in the MEDLINE, Cochrane Library CENTRAL, and EMBASE databases. After removal of duplicates, 850 articles were scrutinized for relevance and validity. Exclusion criteria included: (1) no clear description of the organs involved with the fistula, (2) no description of outcomes after TEVAR for ABF or AEF, or (3) no original data presented in the article. In this manner, 66 relevant articles were identified that included original data on 114 patients (76 men; mean age 63±1.5 years) with ABF (n=71) or AEF (n=43). Meta-analyses were performed to investigate outcomes of TEVAR for ABF and AEF. Results: Patients with AEF presented more frequently with hypovolemic shock (33% versus 13%, p=0.012) and systemic infection (36% versus 9%, p<0.001) compared to patients with ABF. In-hospital mortality was 3% (n=2) after TEVAR for ABF and 19% (n=8) after TEVAR for AEF (p=0.004). Additional thoracic surgery in the first 30 days after TEVAR was performed in 3% (n=2) of ABF patients and in 37% (n=16) of AEF patients (p<0.001); 12 AEF patients who had received esophageal surgery in the first month after TEVAR showed lower fistula-related mortality during 6 months of follow-up compared to patients who did not receive additional esophageal surgery (p=0.018). Conclusion: TEVAR is associated with superior outcomes in patients with ABF. Endovascular management of AEF is associated with poor results and should not be considered definitive treatment. TEVAR could serve as a bridge to surgery for emergency cases of AEF only, with definitive open surgical correction of the fistula undertaken as soon as possible.