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.