Aorto-pleural fistula successfully treated by one-lung ventilation and Endobronchial Watanabe Spigots

Aorto-pleural fistula (APF) is a rare, potentially fatal condition that should be immediately treated by an endovascular or surgical approach. In this case, we treated APF using bronchial occlusion with Endobronchial Watanabe Spigots (EWSs) after one-lung ventilation. Notably, EWS is composed of silicon for endobronchial occlusion under bronchoscopy. An 88-year-old man was referred to our hospital for sudden massive hemoptysis. We maintained the airway by emergent intubation into the right main bronchus through guided bronchoscopy. Computed tomography demonstrated an aortic aneurysm at the aortic arch, penetrating the upper lobe of the left lung. On the 18th hospital day, we performed prophylactic endobronchial occlusion with EWS. The patient was extubated shortly thereafter. Endobronchial occlusion with EWS might be effective in patients with APF who exhibit generally poor conditions. Endobronchial occlusion treatment should be performed after controlling massive bleeding by one-lung ventilation.