B46-07 Recurrent Massive Hemoptysis From Aortobronchial Fistula After Thoracic Aortic Graft Repair: Successful Thoracic Endovascular Aortic Repair (tevar)

Introduction Aortobronchial fistula (ABF) is an uncommon but catastrophic cause of massive hemoptysis, often occurring years after thoracic aortic surgery or trauma. Prompt recognition and intervention are critical to prevent exsanguination. To our knowledge, this is among the few reported cases of recurrent ABF successfully treated with TEVAR after previous aortic graft repair. We present a case of recurrent massive hemoptysis from ABF following prior thoracic aortic graft repair, successfully managed with thoracic endovascular aortic repair (TEVAR). Case Description A 52-year-old man with a history of descending thoracic aortic graft repair presented with recurrent massive hemoptysis, requiring intubation and transfusion. CT angiography revealed contrast extravasation adjacent to the distal graft anastomosis, consistent with an aortobronchial fistula. Bronchial angiography confirmed a complex communication between the left bronchial artery, distal graft, and left lower-lobe bronchus. Embolization was deemed unsafe due to a short arterial segment. Emergent TEVAR using a 31 × 26 × 100 mm Gore TAG stent graft distal to the left subclavian artery successfully excluded the fistula. Hemoptysis resolved completely, and the patient was extubated without complications and was eventually discharged home. At 3-month follow-up, he remained asymptomatic with no recurrence on surveillance imaging. Discussion Aortobronchial fistula should be suspected in any patient with prior thoracic aortic repair presenting with hemoptysis. CT angiography remains the diagnostic modality of choice, while selective bronchial angiography can delineate vascular anatomy for intervention planning. When embolization is unsafe or incomplete, TEVAR offers a rapid, minimally invasive solution to exclude the fistula and control bleeding, with excellent short-term outcomes. Multidisciplinary coordination among pulmonology, interventional radiology, and vascular surgery is vital. Long-term surveillance imaging is required to monitor graft integrity and recurrence. Learning Objectives 1. Recognize aortobronchial fistula as a rare but life-threatening cause of hemoptysis after thoracic aortic repair. 2. Identify diagnostic strategies, including CT and bronchial angiography, for localization and planning. 3. Describe TEVAR as a minimally invasive, life-saving treatment option when embolization or open repair are not feasible. Impact Statement This case highlights the critical importance of early recognition and coordinated multidisciplinary management of massive hemoptysis. TEVAR provides a minimally invasive and durable solution in complex aortobronchial fistulas where conventional approaches are limited. This abstract is funded by: none