Introduction and importance: Aortobronchial fistula (ABF) is a rare complication of descending thoracic aortic pseudoaneurysm and massive hemoptysis. Computed tomography angiography (CTA) is the best modality for diagnosis. Urgent treatment is required for this condition. Case presentation: A 62-year-old man with a history of smoking and 2 years of intermittent hemoptysis was diagnosed with a descending thoracic aortic pseudoaneurysm with a fistula to the bronchi. Despite the initial thoracic endovascular aortic repair (TEVAR), hemoptysis persisted, and clinical evaluations showed a proximal type IA endoleak to the left lung hilum. A carotid–subclavian bypass (CSB) was done to secure the upper limb and vertebral circulation, followed by the deployment of two overlapping stent grafts extending from Zone 2 to the supraceliac region. The patient recovered well, with normal CTA findings at the 1-month follow-up. Clinical discussion: CTA is necessary for diagnosis. TEVAR is the first-line treatment for ABF from a thoracic aortic aneurysm, controlling the bleeding rapidly. Recurrent hemoptysis following TEVAR indicates a proximal type IA endoleak, which requires further intervention. Evidence and guidelines suggest left subclavian artery (LSA) revascularization and careful coverage length to reduce the risk of spinal cord ischemia, with hybrid or staged approaches improving seal durability and reducing recurrence. Because of the complex nature of ABF management, a multidisciplinary team is important for durable outcomes. Conclusion: TEVAR is an effective therapy for ABF. An endoleak is a complication that demands securing proximal and distal landing zones. CSB with extended TEVAR led to recovery, showing the importance of multidisciplinary planning, LSA revascularization, and careful follow-up for durable outcomes.
Salimi et al. (Thu,) studied this question.