Vascular airway compression management in a case of aortic arch and descending thoracic aortic aneurysm

Abstract

Airway compression due to distal aortic arch and descending aortic aneurysm repair has been documented. This case of tracheal and left main stem bronchus compression due to aortic aneurysm occurred in a 42-year-old man. The airway compression poses a challenge for the anesthesiologist in airway management during aortic aneurysm repair surgery. The fiber-optic bronchoscope is very helpful in decision-making both preoperatively and postoperatively in such cases. We report a case of airway compression in a 42-year-old patient who underwent elective distal aortic arch and descending aortic aneurysm repair.

Aortic Arch Aneurysm. Compression Respiratory Complications as a Vital Indication for Emergency Surgery.

“…Tracheobronchial compression syndrome with the aortic arch aneurysms is one of the urgent conditions that needs emergency surgery (3). There is no accurate data presenting the frequency of this complication, although some researchers suggest 5-10% (10).…”

“…It generally occurs because of the close anatomic relationship of the aortic arch to the trachea and the left main bronchus. Clinical manifestations are varying from asymptomatic conditions to acute respiratory failure (3). (Many of the patients were either asymptomatic or otherwise had catastrophic life-threatening events).…”

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...…”

Diagnosis and Surveillance of Aortic Root Dilation

“…Thus, patients can develop dyspnea as the presenting symptom of aortic root dilation up to 40% of the time [68]. Other presenting symptoms may be related to the complications noted in Table 2 [69][70][71][72][73][74].…”