Bronchial artery aneurysm suggested to be caused by metalic tracheal stent migration

Abstract

Occurrence of bronchial artery aneurysm is rare, and it has been detected in less than 1 % of all selective bronchial arteriography cases. Here, we present a case of a bronchial artery aneurysm caused by a tracheal stent migration. A 59-year-old man was operated on for esophageal cancer, where an esophageal-tracheal fistula occurred 1 week after operation. Surgical repair of the esophageal-tracheal fistula was performed using a muscle flap, but this not results in fistula closure. Consequently, a self-expanding covered metallic tracheal stent was implanted for rescue, and this resulted in fistula closure. After 1 year, there was frequent hemoptysis caused by migration of the stent. He was referred to our hospital where removal of the stent was planned. A sudden occurrence of massive bleeding from trachea occurred, and extracorporeal membrane oxygenation (ECMO) was used. Although removal of tracheal stent was performed successfully, the patient subsequently died from multi-organ failure. Post-mortem autopsy revealed that the massive bleeding is originated from the rupture of a bronchial artery aneurysm.

Extracorporeal Life Support in Hemorrhagic Conditions: A Systematic Review

“…68 Tube clamping or selective endobronchial blocking was performed in four patients in the pulmonary hemorrhage subgroup, 40,49,63,65 and embolization of bleeding artery was performed during ECLS in five patients. 33,44,60,61,63 Tube clamping and selective endobronchial blocking were not successful in achieving bleeding control but can be recommended as supportive during ECLS cannulation.…”

“…Through the literature search, 614 articles were found in Pubmed, 488 in Medline, 869 in Embase, and 5 by searching the references in publications included in the analysis (Figure 1). The following subgroups were created based on the bleeding conditions: 1 patient with tracheal injury, 13 11 patients with postpartum or cesarean delivery hemorrhage, 14–19 7 patients with intracranial hemorrhage, 20–25 53 patients with pulmonary hemorrhage, 5,26–66 13 patients with postpulmonary endarterectomy bleeding, 67–72 and 96 patients with bleeding trauma 51,73–96 (Table 1; see Supplementary Tables 1–5, Supplemental Digital Content, http://links.lww.com/ASAIO/A515). Overall, 183 patients were identified in 86 included publications, namely, 74 case reports, 4 case series, 7 retrospective database observational studies, and 1 preliminary results of ongoing study.…”

“…25 For 96 patients, the targets or duration of anticoagulation management was missing. 14,18,19,22,24,25,28–30,32,34,35,42,44,52,56,57,60,63,64,67,68,70,75–78,80,81,83,85–88,91,97,98…”

“…97 Multiple organ failure and futility were the cause of death in nine patients. 56,60,63,70,74,75 Further causes of death were cardiac arrest a few days after ECLS decannulation, 26 respiratory failure, 36 fat embolism, 77 lethal increase in intracranial pressure, 88 pulmonary hypertension, 77 and ECLS futility. 68 In the nine patients, the cause of death was not specified 80 (Table 1).…”

“…6,70 Even in exceptional situations such as tracheal bleeding in a fistula or stent migration, ECLS appears to be useful in supplying hemodynamic stability until further treatment such as surgery can take place. 13,60…”