Aortobronchial fistula is a rare but fatal condition, if not treated surgically. Conventional graft replacement is usually recommended for eradication of the fistula and infection, but mortality and morbidity remain high. Recently the effectiveness of endovascular repair for such cases has been reported. We encountered a case of an 83-year-old man with aortobronchial fistula due to a distal aortic arch aneurysm. The computed tomography (CT) scan showed severe calcification and stenosis in the abdominal aorta and iliac artery, indicating inadequacy for use as access vessels. The patient presented with hemoptysis, and was treated successfully by endovascular repair via the descending aortic conduit. Although the patient had a history of heavy smoking, he fully recovered after surgery and was discharged without any complication. There are potential risks of recurrence of aortobronchial fistula and infection, and we plan to continue close follow-up.

An 82-year-old male patient who had a history of ischemic heart disease (IHD) and Debranching Thoracic Endovascular Aortic Repair (TEVAR) (right axillary artery-left axillary artery-left common carotid artery) was admitted to our hospital due to sudden chest pain. The diagnosis revealed acute coronary syndrome: 2-vessel lesions, including the left main trunk (LMT) (right coronary artery (RCA) #2 75%, #3 90%, LMT #5 50%, and left anterior descending (LAD) branch #7 75%). Plain Old Balloon Angioplasty (POBA) was performed on the responsible lesion, RCA (#2-3). Off-pump Coronary Artery Bypass Grafting (OPCAB) was initially planned for the remaining lesion. However, cardiogenic shock occurred, and an emergency OPCAB (SVG-LAD, SVG-#4PD) was performed via partial sternotomy (inverted L-shaped incision on the left side), using intra-aortic balloon pumping (IABP). The patient underwent revascularization using great saphenous vein grafts due to the potential for postoperative pleuroperitoneal communication in patients undergoing peritoneal dialysis, as well as the risk of impaired internal thoracic artery (ITA) flow caused by debranching in future involving internal shunts for dialysis. It is important to consider not only the graft but also the thoracotomy, taking into account the perspectives of early weaning and the prevention of perioperative complications.