Objective: The aim of the study was to summarize epidemiologic data
about aortobronchial fistulae and compare outcomes (mortality,
recurrence, reoperation) of open, staged, and endovascular repair of
aortobronchial fistula.
Methods: A systematic literature review was conducted to identify
eligible studies published between January 1999 and December 2019. The
Cochrane Library, PubMed, and Scopus databases were used as search
engines. Eligible studies included articles reporting postoperative
outcomes (death/follow-up). Literature review revealed only case reports
and small case series, and thus, only descriptive data with data
heterogeneity were available. The corresponding authors were contacted
to provide additional information or outcome updates
(recurrence/reoperation/death).
Results: Overall, 214 patients (90 studies) underwent 271 procedures
(including redo procedures and staged procedures). Most of the patients
were treated by endovascular means (72.42%). Open surgical repair was
performed in 21.96% and staged procedures in 5.6%. Aortobronchial
fistulae were located most often in the descending thoracic aorta (zone
3 or 4) (64.6%) and in zone 2 (23.8%). Fourteen percent of
aortobronchial fistulae developed after thoracic endovascular aneurysm
repair. Recurrence or infection occurred in 20% (43) patients.
Recurrences were, to some extent, associated with the presence of
endoleak. Long-term antibiotic administration (>1 month) was instituted
in 63 patients (29.4%), whereas 90 patients (42%) did not receive
antibiotics beyond hospitalization. From the remaining 61 patients, 3
received lifelong antibiotics and for 58 patients data were not
available. Considering outcomes, the mean follow-up was 25.1 months
(0188 months) and not significantly different among treatments.
Limitations: Literature review has revealed only case reports and small
case series, and thus, only descriptive data were available. Randomized
controlled trials are not available due to the rarity of the disease,
which significantly decreases the power of the present study. Also, this
study reflects significant data heterogeneity due to the nature of the
analyzed manuscripts and would benefit from large patient cohort studies
that have not been conducted till today.
Conclusions: Aortobronchial fistula is a complex disease. Endoleaks may
be involved in the development and the recurrence process, and they
should not be disregarded. Considering major outcomes (length of
follow-up), the available treating strategies are equal, and thus,
surgeons should feel confident to apply the treatment of their choice,
keeping in mind their experience, patient’s age, and clinical condition
