Endovascular exclusion of an aortobronchial fistula 38 years following a blunt thoracic aortic injury.

Aortobronchial fistula is a rare but life-threatening cause of hemoptysis. We report the case of a 68-year-old man who developed an aortobronchial fistula 38 years after undergoing open repair of a blunt thoracic aortic injury from a plane crash. Initial thoracic endovascular aortic repair was performed covering the area of the previous open repair (zones III/IV) where fistulas typically form; however, persistent symptoms required extension with subsequent resolution of hemoptysis. Six years later, a suspected endograft infection following bronchitis was managed with antibiotics and chronic suppressive therapy. At 9-year follow-up, he remains stable. This case highlights the diagnostic challenges and late infection risk and supports thoracic endovascular aortic repair as a treatment option in selected high-risk patients.