A rare presentation of aorto-bronchial fistula and the relevance of open repair in endovascular era

M. Faizal Effendi Zulkifli, M. Azri Marican, Abdul Rashid M. Radzif, Muhammad Ibrahim Azmi, Mohamad Arif Muhammad, Abdul Muiz Jasid, M. Hamzah Kamarulzaman


Aorto-bronchial fistula is a rare but potentially fatal condition due to torrential bleeding from erosion of aneurysmal wall into bronchial wall or lung parenchyma. It is usually associated with infection, lung transplantation, pulmonary malignancies, atherosclerotic and mycotic aneurysms, and anastomotic pseudoaneurysms after open or endovascular surgery. The typical presentation usually manifested by haemoptysis, but rarely the patient also can be presented with hematemesis and this will delay the definitive treatment. Surgical or endovascular repair is mandatory because non-operative management will lead to a poor prognosis due to massive bleeding from the fistula.  We would like to present a unique case of an elderly man presented with intermittent haematemesis, in which he later developed profound haemoptysis and diagnosed with ABF. Although in the era of endovascular, the ABF was successfully treated via open thoracotomy, resection of thoracic aorta aneurysm, left lower lobe lobectomy, and completed with aortic repair using Gelweave aortic graft.


Aorto-bronchial, Aorta, Bronchus, Fistula, Aneurysm

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Wheatley GH, Nunez A, Preventza O, Ramaiah VG, Lopez RJA, Williams J, et al. Have we gone too far? Endovascular stent-graft repair of aorto-bronchial fistulas. J Thoracic Cardiovascular Surg. 2007;133(5):1277-85.

Sumarsono A, Brown TJ, Atkin SD, Clark J. A 57 years old man with subacute progressive haemoptysis and fevers. Chest. 2018;154(6):181-5.

Weaver ML, Black JH. Aorto-bronchial and aorto-enteric fistula. Seminars Vascular Surg. 2017;30(2-3):85-90.

Chiesa R, Melissano G, Marone EM, Marrocco-Trischitta MM, Kahlberg A. Aorto-oesophageal and aorto-bronchial fistulae following thoracic endovascular aortic repair: a national survey. European J Vascular Endovascular Surg. 2010;39(3):273-9.

Mosquera VX, Marini M, Felipe PF, Martinez GP, Velasco C, Norena HJM, et al. Predictors of outcome and different management of aorto-bronchial and aorto-esophageal fistulas. J Thoracic Cardiovascular Surg. 2014;148(6):3020-6.

Canaud L, Annoville DT, Ozdemir BA, Ane MC, Alric P. Combined endovascular and surgical approach for aorto-bronchial fistula. J Thoracic Cardiovascular Surg. 2014;148(5):2108-11.

Kahlberg A, Tshomba Y, Marone EM, Castellano R, Melissano G, Chiesa R. Current results of a combined endovascular and open approach for the treatment of aorto-esophageal and aorto-bronchial fistulae. Annals Vascular Surg. 2014;28(7):1782-8.