• Medicine · Jun 2018

    Case Reports

    Case report of retrograde in situ fenestration of the thoracic stent graft with reentry device in a patient with aortobronchial fistula.

    • Alexander D Leung and Dai Yamanouchi.
    • Division of Vascular Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA.
    • Medicine (Baltimore). 2018 Jun 1; 97 (24): e11050.

    RationaleIn situ fenestration may be necessary to preserve branch arteries during thoracic endovascular aortic repair (TEVAR) when there is an inadequate landing zone.Patient ConcernsWe report the case of a 74-year-old man presenting with recurrent hemoptysis.DiagnosesBased on computed tomography (CT) angiogram and bronchoscopy, diagnosis was aorto-bronchial fistula.InterventionsWe performed retrograde in situ fenestration with reentry catheter (Pioneer Plus, Volcano Corporation, San Diego, CA) to preserve the left subclavian artery following TEVAR for aorto-bronchial fistula.OutcomesFollowing this procedure, the patient had a patent left subclavian artery and no evidence of endoleak. The patient had no further episodes of hemoptysis.LessonsThe retrograde in situ fenestration with reentry catheter strategy is an option for patients when carotid-subclavian bypass is deemed unsafe.

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