Debranching and Chimney-Assisted Thoracic Endovascular Aortic Repair for Aortopulmonary Fistula From a Ruptured Aortic Arch Aneurysm.

Bungo, Masashi; Watanabe, Ken-Ichi; Teshima, Yoshio; Sakashita, Yuji; Uemura, Hisashi; Yamamura, Mitsuhiro; Sakaguchi, Taichi · Ann Thorac Surg · 2026

case_report · Level V

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Abstract

An aortopulmonary fistula is a rare but catastrophic complication of thoracic aortic aneurysm rupture. An 80-year-old woman presented with shock, respiratory failure, and severe lactic acidosis. Contrast-enhanced computed tomography demonstrated a ruptured saccular aortic arch aneurysm with an aortopulmonary fistula to the left pulmonary artery. Emergent hybrid thoracic endovascular aortic repair with supra-aortic debranching and a chimney graft achieved prompt fistula exclusion. Although a small gutter-related type Ia endoleak persisted, hemodynamics improved. Postoperative computed tomography confirmed aneurysm sac thrombosis and complete fistula closure.