Atypical chest pain and hemoptysis 27 years after aortic coarctation surgery: aortobronchial fistula, management and endovascular treatment.

Aortobronchial fistula (ABF) is a rare, late, and usually catastrophic complication that should be suspected in any patient who has undergone a surgical procedure involving descending thoracic aorta. It usually presents as atypical chest pain that is followed by massive hemoptysis and death due to blood loss if emergency surgery is not performed. Our patientwas a 39-year-oldman,whose only notablemedical event had been surgical repair of aortic coarctation with patch enlargement 27 years earlier andwho, after several days of intense atypical chest pain, came to our center because his condition had deteriorated and he had developed hemoptysis, with a loss of over 600 mL of blood. Given his history of previous aortic surgery with no other risk factors, emergency contrast-enhanced computed tomographic angiography (CTA) was requested. This study revealed a true aneurysmmeasuring 71 mm 71 mm in diameter, located 11 mm distal to the orifice of left subclavian artery, confirmed by aortography (Fig. 1); thus, the decision was made to perform an emergency endovascular surgical intervention. After dissection of left common femoral artery, a Medtronic Valiant thoracic aortic endograft (Medtronic, Santa Monica,