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

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.