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J u l y 2 3 - 2 4 , 2 0 1 8 | R o m e , I t a l y

allied

academies

Joint Event on

Cardiology Congress 2018 & Microbe Infection 2018

Biomedical Research

ISSN: 0976-1683

Volume 29

World Congress on

CARDIOLOGY

MICROBIOLOGY AND MICROBIAL INFECTION

Annual Congress on

Biomed Res 2018, Volume 29 | DOI: 10.4066/biomedicalresearch-C1-003

DEVELOPMENT OF AORTIC FISTULAS INTO THE BRONCHIAL TREE AND

LUNG PARENCHYMA FOLLOWING CARDIAC SURGERY

Marco Picichè

Vicenza San Bortolo Hospital, Italy

ortic fistulas into the airways may develop after unpredictable periods after surgery and are often the consequence of

pseudoaneurysms. They are more common after descending thoracic aorta (DTA) procedures. Postoperative aortic

pseudoaneurysms (PSAs) may arise from disruption of one or more arterial wall layers with extravasation of blood into the

surrounding spaces. The hematoma is then held by the remaining vascular layers, fibrous tissue, and sometimes the parietal

pericardium. A neointima may develop. Disruption may be related to different sites depending on the type of operation. A PSA is

not the only possible cause of bronchopulmonary damage, which may also be due to neoaneurysms involving the native aortic

wall next to suture lines. In other cases slow but continuous damage to lung parenchyma is caused by strictly adjacent foreign

material such as graft substance, remnant of temporary bypass, silk knots and suture material, endobronchial expandable metal

stents, or kinking of an aortic stent-graft. Hemoptysis is the first (and often the only) symptom of aortic fistulas into the bronchial

tree or lung parenchyma. It may be massive or intermittent, depending on the size of the opening. If left untreated, ABPFs are

uniformly fatal. Management of the airways must be immediate and must first include bleeding control by selective endotracheal

intubation. The inflated cuff of a Carlens tube or a Fogarty embolectomy catheter may be positioned into the bleeding side of

bronchial tree to protect the contralateral side from hemorrage. Otherwise a single-lumen endotracheal tube may be positioned

in the healthy main stem bronchus. Various approaches have been described, either surgical or endovascular. When the fistula

is located in the ascending aorta, femoral–femoral cannulation should be established before opening the sternum, as the false

aneurysm may potentially rupture during sternotomy.