Thoracic Aortic Aneurysm: A Case Report
A 74-year-old woman with sudden chest pain and dyspnea was admitted to the emergency room and intubated on arrival owing to disturbed consciousness. She was a known case of hypertension but no history of asthma or chronic obstructive pulmonary disease. Chest radiography showed mediastinal widening.

Computed tomography (CT) of the chest revealed rupture of the descending thoracic aortic aneurysm, which compressed the lower trachea and both main bronchi. The maximal diameter of the aneurysm at the level of the Carina was 9 cm. The surgeons performed an emergency thoracic endovascular aortic repair (TEVAR, seal stent graft S&G Biotech Inc., Yongin-si, Korea, proximal 34 × 30 × 110 and distal 28 × 110).

However, even with the mechanical ventilator support, carbon dioxide (CO2) retention was not easily resolved, and sudden oxygen desaturation with unusually high airway pressure and low tidal volume was repeated. Due to the failure to wean the patient from the mechanical ventilator, the follow-up chest CT was performed. Despite the stent graft in the aorta, the hematoma of the ruptured aneurysm continued compressing the lower trachea and both main bronchi.

Because the patient crashed owing to respiratory failure, she immediately underwent veno-veno extracorporeal membrane oxygenation (VV ECMO) support and subsequently, insertion of the silicone stent. However, the day after insertion, the silicone stent in the bronchi migrated upward owing to the extrinsic pressure and obstructed the carina. Therefore it had to removed.

Through multidisciplinary cooperation with radiology, the operating surgeons planned to insert a metallic stent. The day after nitinol stent insertion, hypoventilation and CO2 retention improved, and the patient was able to remove VV ECMO.

Source: https://cardiothoracicsurgery.biomedcentral.com/articles/10.1186/s13019-019-0992-x
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