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Jaffar Khan M, Baykuziyev T, Tageldin T, Albasha A. Anesthetic Challenges in a Patient With an Expanding Recurrent Mycotic Pseudoaneurysm of the Right Brachiocephalic Artery: A Case Report and Literature Review. Cureus 2024; 16:e55372. [PMID: 38562318 PMCID: PMC10983777 DOI: 10.7759/cureus.55372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Airway obstruction requires urgent intervention. When dealing with the right brachiocephalic artery mycotic pseudoaneurysms, the risk of rupture and massive hemorrhage adds greater urgency to the management. Furthermore, tracheal compression presents difficulties during airway management. This report highlights the airway and anesthetic challenges encountered during the procedure and emphasizes the importance of tailored intervention for optimal patient care. We describe the clinical case of a 38-year-old male patient who presented with a large recurrent right brachiocephalic artery pseudoaneurysm associated with tracheal compression. The patient required urgent surgical intervention due to the pseudoaneurysm's enlargement and progressive respiratory distress. Awake fiber-optic intubation was not feasible. A cardiopulmonary bypass was kept on standby in the event of failed intubation and ventilation, or circulatory collapse. Endotracheal intubation was performed successfully using a video-laryngoscopy. After successful surgical repair of the pseudoaneurysm, the patient was transferred to ICU where he was extubated 48 hours post-surgery, following treatment with methylprednisolone for edematous aryepiglottic folds identified during video-laryngoscopy. Overall, this case emphasizes the importance of early diagnosis, prompt surgical intervention, and effective teamwork in managing rare and potentially life-threatening conditions like mycotic pseudoaneurysms. It also highlights the critical role of anesthesiologists in providing optimal perioperative care, ensuring hemodynamic stability, managing airway challenges, and facilitating successful surgical outcomes. In our work, we also provide a summary of the reported similar cases.
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Affiliation(s)
- Muhammad Jaffar Khan
- Anesthesiology, ICU and Perioperative Medicine, Hamad Medical Corporation, Doha, QAT
| | - Temur Baykuziyev
- Anesthesiology, ICU and Perioperative Medicine, Hamad Medical Corporation, Doha, QAT
| | - Tarek Tageldin
- Anesthesiology, ICU and Perioperative Medicine, Hamad Medical Corporation, Doha, QAT
| | - Abdulatif Albasha
- Anesthesiology, ICU and Perioperative Medicine, Hamad Medical Corporation, Doha, QAT
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Montane-Muntane M, Ascaso M, Rivera-Vallejo L, Navarro-Ripoll R. Difficult ventilation in a patient with a giant aortic aneurysm: A challenge for the anesthesiologist. Ann Card Anaesth 2023; 26:86-89. [PMID: 36722594 PMCID: PMC9997479 DOI: 10.4103/aca.aca_309_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Patients with Marfan syndrome present anatomic variations that may increase the risk of a difficult airway. Moreover, they can present large aortic aneurysms, which may cause extrinsic airway compression. Therefore, difficult ventilation during general anesthesia poses a challenge in that the anesthesiologist has to promptly make a crucial differential diagnosis. Multidisciplinary preoperative assessment and planning of the airway and ventilation management are of utmost importance in such uncommon and highly complex clinical cases. Fiberoptic bronchoscopy is probably a really useful tool in order to assess the severity and extent of the airway compression, both preoperatively and intraoperatively. We present a clinical case where difficult ventilation occurred immediately after the induction of general anesthesia.
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Affiliation(s)
- Mar Montane-Muntane
- Department of Anesthesiology, Hospital Clínic de Barcelona, Barcelona, Catalonia
| | - María Ascaso
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, Barcelona, Catalonia
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Lester LC, Kostibas MP. Anesthetic Management for Open Thoracoabdominal and Abdominal Aortic Aneurysm Repair. Anesthesiol Clin 2022; 40:705-718. [PMID: 36328624 DOI: 10.1016/j.anclin.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Open thoracoabdominal and abdominal aortic aneurysm repairs are some of the most challenging cases for anesthesiologists because of the potential for rapid blood loss combined with clamping and reperfusion, potential use of left heart bypass, the potential need for lung isolation, and potential placement and management of a spinal drain. In addition, patients often present with other significant comorbidities and a detailed understanding of the disease process, the complex physiology throughout the case, and the intricacies of organ protection are critical.
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Affiliation(s)
- Laeben Chola Lester
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Zayed 6212, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Megan P Kostibas
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Zayed 6212, 1800 Orleans Street, Baltimore, MD 21287, USA.
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Hakkenbrak NAG, Truijers M, Thomassen I. Thoracic Endovascular Aneurysm Repair and Tracheal Stenting for Respiratory Failure due to a Thoracic Aortic Aneurysm: A Case Report. Vasc Endovascular Surg 2022; 56:514-516. [PMID: 35363099 PMCID: PMC9163772 DOI: 10.1177/15385744221085814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An 82-year-old male was referred to the emergency department for severe respiratory distress. Computed tomography angiography showed tracheal compression due to a large ruptured saccular aneurysm of the descending thoracic aorta. Emergency Thoracic Endovascular Aneurysm Repair (TEVAR) was performed. To reduce tracheal compression, an endotracheal stent was placed (silicone Dumon©). Following surgery, respiratory function improved. Two days after the surgery, the patient refused further invasive treatment, including mechanical mucus aspiration from the endotracheal stent, and palliative sedation was initiated. Conventional treatment to reduce tracheal compression by a saccular aortic aneurysm is open surgical aneurysm repair. If open repair is contraindicated because of patient age, comorbidity, or in case of severe hemodynamic instability following aneurysm rupture, TEVAR with endotracheal stent placement may serve as a bridge to definite surgery to reduce tracheal compression.
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Affiliation(s)
- Nadia A G Hakkenbrak
- Department of vascular surgery, Amsterdam UMC, 1209Location VU Medical Centre, Amsterdam, The Netherlands.,Department of vascular surgery, 1140Northwest Clinics, Alkmaar, The Netherlands
| | - Maarten Truijers
- Department of vascular surgery, Amsterdam UMC, 1209Location VU Medical Centre, Amsterdam, The Netherlands.,Department of vascular surgery, 3670Spaarne Gasthuis, Haarlem, The Netherlands
| | - Irene Thomassen
- Department of vascular surgery, Amsterdam UMC, 1209Location VU Medical Centre, Amsterdam, The Netherlands.,Department of vascular surgery, 1140Northwest Clinics, Alkmaar, The Netherlands
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Left main bronchus compression by aneurysm and kinking of the descending aorta. COR ET VASA 2021. [DOI: 10.33678/cor.2021.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Dinh K, Manual L, Vicaretti M. Vascular Tracheobronchial Compression Syndrome Secondary to Contained Ruptured Thoracic Aortic Aneurysm. Interv Cardiol 2021; 16:e16. [PMID: 34367331 PMCID: PMC8327275 DOI: 10.15420/icr.2021.16.po5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Komarov R, Ismailbaev A, Kurasov N, Ivashov I, Saliba M, Danachev A. Aortic arch aneurysm. Tracheobronchial compression as a vital indication for emergency surgery: A case report. Int J Surg Case Rep 2021; 85:106218. [PMID: 34333254 PMCID: PMC8346636 DOI: 10.1016/j.ijscr.2021.106218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Giant thoracic aortic aneurysms and aortic arch dissections are accompanied by high mortality rates, cardiac and neurologic events and pulmonary complications. Tracheobronchial compression with aorta-tracheal fistula is a rare complication of the aorta aneurysms. Aortic arch replacement in such case presents several formidable challenges. PRESENTATION OF CASE This is the case report of successful surgical treatment of giant aortic arch aneurysm, complicated by airway compression, aorta-tracheal fistula and recurrent community-acquired pneumonia. DISCUSSION Urgent indications for the aortic arch aneurysms surgery include significant size and high risk of rupture. As well as a visceral compression are presented. Bronchoscopy can be used to successfully treatment at all stages from trachea intubation to extubation. CONCLUSION Aggressive surgical approach with careful pre-operative diagnostic are the key to success and the only one chance for patients with aortic arch aneurysm, complicated by airway compression.
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Affiliation(s)
- Roman Komarov
- Department of Cardiovascular Surgery, Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation
| | - Alisher Ismailbaev
- Department of Cardiovascular Surgery, Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation
| | - Nikolay Kurasov
- Department of Cardiovascular Surgery, Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation
| | - Ivan Ivashov
- Department of Cardiovascular Surgery, Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation.
| | - Maxim Saliba
- Department of Cardiovascular Surgery, Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation
| | - Alexander Danachev
- Department of Cardiovascular Surgery, Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation
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Dinh K, Manuel L, Somers M, Vicaretti M. Vascular tracheobronchial compression syndrome secondary to contained ruptured thoracic aortic aneurysm. J Surg Case Rep 2021; 2021:rjab147. [PMID: 34025968 PMCID: PMC8128389 DOI: 10.1093/jscr/rjab147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/20/2021] [Accepted: 03/23/2021] [Indexed: 11/16/2022] Open
Abstract
Vascular tracheobronchial compression syndrome is the compression of the trachea or pulmonary bronchus by a vascular structure. It is primarily a diagnosis in children and secondary to congenital vascular anomalies. In adults, vascular tracheobronchial compression syndrome can be either congenital or required with a vast majority of congenital conditions found incidentally on imaging. Acquired conditions are largely due to aortic arch aneurysms or kinking of the aorta. The case described herein illustrates the rare case of a saccular thoracic aneurysm causing compression of the left primary bronchus. Patients may have a history of gradual onset of symptoms involving both the airway and oesophagus. Vascular tracheobronchial compression syndrome may go undetected and asymptomatic throughout an individual’s lifespan, however as described herein this syndrome may also be life-threatening.
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Multimodality Imaging of Aortic Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00831-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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DeAndrade DS, Smith NF, McHugh SM. Airway Compression During Transcatheter Aortic Valve Replacement via Subclavian Artery Approach: A Case Report. A A Pract 2019; 12:329-331. [PMID: 30431441 DOI: 10.1213/xaa.0000000000000927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is an alternative to traditional surgery in patients considered to be at high or intermediate risk for open surgical repair of aortic stenosis. Despite its overall safety and efficacy, TAVR is associated with potentially serious complications including major vascular injury. Tracheal compression resulting from vascular pathology has been previously reported; however, airway compromise secondary to vascular injury during TAVR has not been described. We report a case of airway compression and respiratory compromise resulting from injury to the right subclavian artery during TAVR.
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Affiliation(s)
- Diana S DeAndrade
- From the Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nicholas F Smith
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stephen M McHugh
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Hankins SJ, Tolpin DA. Ascending Aortic Aneurysm Causing Right Ventricular Outflow Tract Obstruction and Severe Tricuspid Regurgitation. J Cardiothorac Vasc Anesth 2018; 32:441-444. [DOI: 10.1053/j.jvca.2017.03.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Indexed: 11/11/2022]
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12
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Kennedy A, Falcetto S. Editorial. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2017. [DOI: 10.1016/j.tacc.2017.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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