Case report of retrograde in situ fenestration of the thoracic stent graft with reentry device in a patient with aortobronchial fistula

Rationale: In situ fenestration may be necessary to preserve branch arteries during thoracic endovascular aortic repair (TEVAR) when there is an inadequate landing zone. Patient concerns: We report the case of a 74-year-old man presenting with recurrent hemoptysis. Diagnoses: Based on computed tomography (CT) angiogram and bronchoscopy, diagnosis was aorto-bronchial fistula. Interventions: We performed retrograde in situ fenestration with reentry catheter (Pioneer Plus, Volcano Corporation, San Diego, CA) to preserve the left subclavian artery following TEVAR for aorto-bronchial fistula. Outcomes: Following this procedure, the patient had a patent left subclavian artery and no evidence of endoleak. The patient had no further episodes of hemoptysis. Lessons: The retrograde in situ fenestration with reentry catheter strategy is an option for patients when carotid-subclavian bypass is deemed unsafe.