Abstract Introduction Continued enlargement of the aneurysm sac after endovascular aortic repair is a known risk after endovascular treatment of thoracic aortic aneurysms Despite advancements in endovascular techniques, endo leaks persist as a significant challenge unique to stent grafting, not encountered in open surgical repair. Case report A 64-year-old male with a history of endovascular ascending aortic aneurysm repair with (TEVAR), alcohol use disorder, hypertension, and type 2 diabetes mellitus presented with an out-of-hospital PEA arrest following an episode of massive hemoptysis and collapse. In the ED, the patient was intubated but experienced two additional PEA arrests.On admission a CTA chest revealed a 5 cm ascending aortic aneurysm, a 2.1 cm descending aortic aneurysm, and diffuse bilateral pulmonary infiltrates, more severe in the left lung. Echocardiography showed normal function (EF ∼60%) with a dilated ascending aorta (4.87 cm) and mild aortic regurgitation. Admitted to the ICU, the patient required mechanical ventilation and was managed empirically for possible septic shock and ARDS. Bronchoscopy revealed clotted blood but no active bleeding, malignancy, or organisms, 400 mL of bright blood was suctioned. A repeat CTA chest identified a 2.1 x 1.5 cm saccular aneurysm at the aortic arch/descending aorta junction with active extravasation, consistent with an aortobronchial fistula. Extensive left lung hemorrhage and subclavian artery perfusion through the fistula were noted. The patient was then transferred to a tertiary center, where repeat imaging revealed severe anoxic brain injury and massive intracranial hemorrhage. Prognosis remained poor and patient was transitioned to comfort measures. Discussion Endoleaks, defined as blood extravasation outside the stent graft lumen, can complicate endovascular treatment of aortic disease, leading to aneurysm enlargement or rupture. Endoleaks, defined as blood extravasation outside the stent graft lumen, can complicate endovascular treatment of aortic disease, leading to aneurysm enlargement or rupture. Aortobronchial fistula (ABF), where an aneurysm erodes into the bronchial tree or pulmonary parenchyma, presents with catastrophic hemoptysis and carries a high mortality. While thoracic endovascular aortic repair (TEVAR) achieves a 96% freedom from aneurysm-related death, up to 14% of patients may require reintervention within five years due to complications like aneurysmal progression. The case highlights the importance of thorough history-taking and heightened clinical suspicion in post-TEVAR patients presenting with hemoptysis. Endoleaks remain a pivotal complication following thoracic endovascular interventions and emphasize the need for vigilant long-term surveillance. This abstract is funded by: None
Carter et al. (Fri,) studied this question.