Effective Strategies for Managing Sudden Hemoptysis Caused by Aorto-Bronchial Fistula during Cardiopulmonary Bypass: A Case Report

Aorto-bronchial fistula (ABF) is a rare but life-threatening complication that can occur after thoracic endovascular aortic repair (TEVAR). The ABF clinical diagnosis can be challenging due to its insidious symptoms and potential for misdiagnosis. Managing endobronchial hemoptysis caused by ABF during cardiopulmonary bypass (CPB) is challenging due to limited clinical experience. We present a case of a patient who was previously treated with TEVAR for a thoracic aortic dissection and endovascular abdominal aortic aneurysm repair for an abdominal aortic aneurysm. The patient was admitted with intermittent hemoptysis over 1 year and chest pain for 3 days. Aortic computed tomography angiography (CTA) showed a recurrent dissection of the aortic arch. We encountered endotracheal hemoptysis during total arch replacement combined with a stented frozen elephant trunk under CPB. Due to the patient's prior history of TEVAR, the ABF was eventually diagnosed during the procedure; however, with the implementation of a series of measures, we were able to successfully resuscitate the patient. The literature suggests that this may be an exceedingly rare case of ABF successfully treated during CPB. Currently, there are no established clinical guidelines or consensus for the diagnosis and treatment of ABF after TEVAR due to the lack of case reports with extensive data. Timely identification of the bleeding bronchus, early activation of blood cell salvage, early neutralization of heparin activity, and timely resection of the diseased lobe are key to treating patients with ABF during CPB.