Advertisement

Aorto-bronchial fistula after implantation of a self-expanding bronchial stent in a patient with aortic dissection

  • Yoshihiko Katayama
  • Hitoshi Suzuki
  • Tetsuo Mizutani
Case Report

Abstract

We report a case of aorto-bronchial fistula after implantation of a self-expanding stent into the left main bronchus compressed by a dissected descending aorta. A 66-year-old female, who underwent Stanford type-B aortic dissection two years previously, was admitted to our hospital for the treatment of a newly developed false lumen that originated from the ascending aorta and extended to the aortic bifurcation. She was unable to be weaned from the respirator after the graft replacement of the ascending aorta. Fiberoptic bronchoscopic examination revealed complete obstruction of the left main bronchus by extrinsic compression. A self-expanding nitinol stent was implanted in the left main bronchus five days after the operation. Her respiratory condition improved remarkably, allowing her to be successfully weaned from the respirator. Her clinical course was uneventful until she suddenly died from massive hemoptysis 20 days after stent implantation. A communication of 5 mm in diameter between the dissected descending aorta and the left main bronchus was seen at autopsy. Permanent application of a self-expanding nitinol stent to relieve extrinsic compression of a left main bronchus by a dissected descending aorta is not recommended because pressure necrosis might lead to fatal aorto-bronchial fistula.

Index words

aortic dissection aorto-bronchial fistula self-expanding stent 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Wassermann K, Eckel HE, Michel O, Müller RP. Emergency stenting of malignant obstruction of the upper airways: long-term follow-up with two types of silicone prostheses. J Thorac Cardiovasc Surg 1996; 112: 859–66.PubMedCrossRefGoogle Scholar
  2. 2.
    Freitag L, Eicker R, Linz B, Greschuchna D. Theoretical and experimental basis for the development of a dynamic airway stent. Eur Respir J 1994; 7: 2038–45.PubMedGoogle Scholar
  3. 3.
    Becker HD. Stenting of the central airways. J Bronchology 1995; 2: 98–106.CrossRefGoogle Scholar
  4. 4.
    Nashef SA, Dromer C, Velly JF, Labrousse L, Couraud L. Expanding wire stents in benign tracheobronchial disease: indications and complications. Ann Thorac Surg 1992; 54: 937–40.PubMedCrossRefGoogle Scholar
  5. 5.
    Duerig TW, Pelton AR, Stockel D. Superelastic nitinol for medical devices. Medical Plastics and Biomaterials 1997; March/April: 31–42.Google Scholar
  6. 6.
    Ewert R, Mutze S, Meyer R, Thieme T, Witt C. Stent implantation in severe tracheal and bronchial compression caused by aortic aneurysm. Pneumologie 1997; 51: 19–23.PubMedGoogle Scholar
  7. 7.
    Watanabe S, Toyohira H, Yamaoka A, Yotsumoto G, Shiota K, Taira A. Usefulness of Dumon-type endotracheal stent for left main bronchial obstruction caused by thoracic aortic aneurysm-a case report (Eng abstr). J Jpn Assn Thorac Surg 1996; 44: 1776–80.Google Scholar
  8. 8.
    Slonim SM, Razavi M, Kee S, Semba CP, Dake MD. Transbronchial Palmaz stent placement for tracheobronchial stenosis. J Vasc Interv Radiol 1998; 9: 153–60.PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Society of Thoracic and Cadiovascular Surgery 2000

Authors and Affiliations

  • Yoshihiko Katayama
    • 1
  • Hitoshi Suzuki
    • 1
  • Tetsuo Mizutani
    • 1
  1. 1.Department of Thoracic and Cardiovascular SurgeryMie General Medical CentreMieJapan

Personalised recommendations