Thoracic aortic aneurysms exerting high extrinsic pressure on the airway

Abstract

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 The patients’ hypoventilation resolved, and the patient was withdrawn from the ventilator.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.

Histone Deacetylase Inhibition Attenuates Aortic Remodeling in Rats under Pressure Overload

“…Thoracic aortic diseases such as thoracic aortic aneurysms and aortic dissections are rarely diagnosed until symptoms appear, at which point patients risk a fatal aortic rupture [1]. Hypertension is well known as the most common risk factor for thoracic aortic diseases, but it is still not fully understood how increased pressure on the ascending aorta leads to aortic remodeling [2].…”

Airway management in vascular central airway obstruction: a literature review

“…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,…”

“…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...…”

“…Trachea and extrapulmonary bronchi are composed of hyaline cartilage that is resistant to external compression. When intrinsic wall weakness of the airway [86] or high external pressure that over the air column can stand, extrinsic CAO occurs [82]. Therefore, some patients present with asymptomatic vascular CAO [47][48][49]56], and the others commonly demonstrate chest discomfort, including chronic cough, recurrent bronchopulmonary infections, stridor, hoarseness, and wheezing [27,40,53,76].…”

“…Endotracheal stenting is a therapeutic option for airway stenosis [75]. Technological improvement in endobronchial procedures has provided more options for managing complex cases [77,82]. In extrinsic vascular CAO, the trachea may be compressed by vascular lesions with high pressure that metallic endobronchial stents rather silicon stent can stand [75,82]; variable tracheal compression and collapse requires expandable stents [83]; and the possibility of coexistence with tracheomegaly needs a custom-made and fully covered metallic stent [77].…”