{'fraction_non_alphanumeric': 0.023913775682047826, 'fraction_numerical': 0.001684068710003368, 'mean_word_length': 5.49890590809628, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Commentary: Stent-Graft Repair of Aortobronchial Fistula: Who are we Kidding?

Thoracic aortic stent-grafts have emerged as an incredibly useful technology for patients with thoracic aortic aneurysms located distal to the left subclavian artery and proximal to the celiac artery. Successful on-label use of these endoprostheses to treat complex aneurysmal disease of the descending thoracic aorta has compared favorably with open surgical results in small multicenter prospective studies designed for regulatory approval. However, long-term data concerning the stability of aneurysm exclusion with an aortic stent-graft and long-term freedom from aneurysm-related death in these patients has yet to be accumulated. Nevertheless, midterm results have shown comparable results compared to open surgical repair. It is only natural that we as physicians would explore off-label use of thoracic aortic stent-grafts for aortic diseases other than aneurysms as a strategy to offer treatment to patients who have prohibitive surgical risk. Almost every conceivable thoracic aortic disease has been treated in some form using a stent-graft. There are many ethical, research, and clinical questions surrounding these off-label uses, and each unique disease treatment should be looked at on its own independent merits. The biggest mistake we could make—for our patients’ sake—would be to lump all of these off-label uses into a collective pool for scrutiny and risk, overlooking potentially useful and successful opportunities to extend the real world application of thoracic aortic stent-graft technology beyond aneurysms. Of all the potential extended applications for which thoracic aortic stent-grafting has been described, one of the most ‘‘illogical’’ applications is for aortobronchial fistulas. The thought of placing an endovascular stentgraft in a contaminated vascular field seems on face value counterintuitive to basic surgical and medical principles. The real question here is ‘‘Who are we kidding?’’ In their report, De Rango et al. explore the sum total peer-reviewed literature relating to thoracic aortic stent-grafting for aortobronchial fistulas (ABFs). This thorough and comprehensive manuscript is an erudite treatise that systematically addresses all important aspects of this controversial issue. This study represents the largest systematic analysis to date of aortic stent-grafting for ABFs, surpassing a recently published and equally superb meta-analysis of thoracic fistulas (aortobronchial and aortoesophageal). A total of 82 patients with ABFs have been treated with thoracic aortic stent-grafts. Multiple types of stent-grafts were used for treatment, and there were no perioperative mortalities reported. Surprisingly, no periprocedural cases of paraplegia or stroke were described. There was a 13% incidence of recurrent hemorrhage, and 1 patient expired from sepsis. There were no standardized protocols for postoperative antibiotic prophylaxis.