Metallic stents for rescuing a patient with severe upper airway compression due to aortic aneurysm

Chen, Wei Chun; Tu, Chih Yen; Liang, Shinn-Jye; Liu, Juhn Cherng; Chen, Wei

doi:10.1016/j.ajem.2008.06.034

Cited by 9 publications

(8 citation statements)

References 13 publications

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“…There are reports about multistep management of thoracic aortic aneurysm using endovascular and endobronchial approach [1, 2, 5, 6] or VV ECMO application during variant airway problems [7, 8]. However, none of them reported about the extrinsic pressure of the ruptured aneurysm and how high it might be.…”

Section: Discussionmentioning

confidence: 99%

Thoracic aortic aneurysms exerting high extrinsic pressure on the airway

Jung

Woo

Lee

et al. 2019

J Cardiothorac Surg

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Background Thoracic aortic aneurysms, although mostly asymptomatic, are life threatening owing to the risk of rupture. Moreover, the extrinsic pressure of a ruptured aneurysm may encroach the mediastinum. Case presentation A 74-year-old woman diagnosed with ruptured descending thoracic aortic aneurysm compressing the lower trachea and both main bronchi underwent thoracic endovascular aortic repair; however, the extrinsic pressure on the airway persisted. Following failing of endobronchial silicon stents insertion, extracorporeal membrane oxygenation support was required, and endobronchial metallic stents were inserted. The patients’ hypoventilation resolved, and the patient was withdrawn from the ventilator. Conclusions Technological improvement in endovascular or endobronchial procedures has provided more options for managing complex cases. However, we must be aware of how high the extrinsic pressure might be before management and take steps to minimize complications.

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Section: Discussionmentioning

confidence: 99%

Thoracic aortic aneurysms exerting high extrinsic pressure on the airway

Jung

Woo

Lee

et al. 2019

J Cardiothorac Surg

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“…An ongoing expansion of a thoracic aortic aneurysm can compress the surrounding structures including the esophagus, superior vena cava or innominate vain and large airways. Moreover, compression of the left main bronchus, left pulmonary artery, trachea or mainstem bronchus has been reported (11,12). As a result, these patients should be carefully examined and evaluated before surgery.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic Management in a Patient With Type A Aortic Dissection and Superior Vena Cava Syndrome

Totonchi¹,

Givtaj²,

Sakhaei³

et al. 2015

Res Cardiovasc Med

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Introduction: Induction of general anesthesia in patients with superior vena cava (SVC) syndrome may cause airway obstruction and cardiovascular collapse. Case Presentation: Herein, we introduced a patient with the diagnosis of dissecting aneurysm of the ascending aorta who was candidate for emergency surgery. He also had symptoms of SVC syndrome. To maintain airway patency during anesthetic management, we decided to perform femoro-femoral cardiopulmonary bypass followed by general anesthesia and tracheal intubation. Conclusions: Femoro-femoral bypass prior to initiation of sternotomy is a safe and easy method in patients with aortic dissection and SVC syndrome in whom earlier endotracheal intubation may not be feasible.

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“…Table 3 shows acquired extrinsic vascular CAO caused by arterial aneurysm of central vascular system or extremely thoracic anatomy. Arterial aneurysms of the innominate artery [20,26,[67][68][69][70][71], ascending aorta [71][72][73][74], aortic arch [73][74][75][76][77][78], descending thoracic aorta [74][75][76][79][80][81][82][83][84], and common carotid artery [85][86][87]] that compress the central airway are secondary to atherosclerotic degeneration [20,68,69,[73][74][75][76][82][83][84], heritable connective tissue disease [77][78][79][80], infection process [67,81,85,86,…”

Section: Congenital Vascular Anomaliesmentioning

confidence: 99%

“…Aortic aneurysm of ascending aortic [71][72][73][74] Aortic aneurysm of aortic arch [73][74][75][76] Aortic aneurysm of thoracic aorta [74][75][76][82][83][84] Aneurysm of innominate artery [20,26,[68][69][70] Aneurysms of the ascending aorta and innominate artery [71] Ruptured thoracic aortic aneurysm [23] Heritable connective tissue disease Aortic aneurysm of thoracic aorta in Marfan's disease [77][78][79] Aortic aneurysm of thoracic aorta and innominate artery in Marfan disease [79] Aortic aneurysm of thoracic aorta in heritable connective tissue disease [80] Aortic dissection Dissected internal carotid artery [87] Dissected descending aorta [89] Infection process Mycotic common carotid aneurysm (Staphylococcus aureus) [85,86] Mycotic descending aortic aneurysm (Staphylococcus aureus) [81] Syphilitic aortic arch aneurysms [88] Syphilitic innominate aneurysms [67] Pulmonary artery system Pulmonary artery aneurysm [90,91] Pulmonary artery pseudoaneurysm [91] Pulmonary artery dilation [92][93][94] Extremely abnormal thoracic anatomy [95] Severe kyphoscoliosis resulting in trachea compressed by the innominate artery anteriorly and thoracic spine posteriorly in Marfa...…”

Section: Atherosclerotic Degenerationmentioning

confidence: 99%

“…Difficult intubation [56], persistent hypercapnia with/or without oxygen desaturation after trachea intubation [26,75], difficulty in passing through the suction tube [75,79], difficulty in weaning from mechanical ventilation [79], and extubation failure that presents with smooth breathing when using endotracheal tube but becoming airflow limitation soon after remove the endotracheal tube [59,79,86] should be signs that alert doctors to exclude the possibilities of vascular CAO. Mechanical ventilation variability is another sign of tracheal compression [26,75,81,109], which explains why the patients with CAO still present with low tidal volume, hypercapnia, and arterial oxygen desaturation under the assistance of artificial positive-pressure ventilation.…”

Section: Signs Of Unexpected Vascular Caomentioning

confidence: 99%

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Airway management in vascular central airway obstruction: a literature review

Lee¹,

Chao²,

Hung³

et al. 2021

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Vascular central airway obstruction (CAO) is a rare cause of upper airway obstruction in adults. CAO occurs below the level where it is invisible in a laryngoscope. Doctors therefore should pay attention to the possibilities of vascular CAO when attempting to prevent and resolve catastrophic complications from upper airway obstruction such as cardiorespiratory collapse and hemoptysis, which requires a thoughtful preoperative planning of airway management before starting a surgical reconstruction.

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Metallic stents for rescuing a patient with severe upper airway compression due to aortic aneurysm

Cited by 9 publications

References 13 publications

Thoracic aortic aneurysms exerting high extrinsic pressure on the airway

Thoracic aortic aneurysms exerting high extrinsic pressure on the airway

Anesthetic Management in a Patient With Type A Aortic Dissection and Superior Vena Cava Syndrome

Airway management in vascular central airway obstruction: a literature review

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