SESSION TITLE: Interventional Pulmonary Cases
SESSION TYPE: Affiliate Case Report Slide
PRESENTED ON: Sunday, October 25, 2015 at 10:45 AM - 11:45 AM
INTRODUCTION: Etiologies of airway obstruction vary widely from benign to malignant, with manifestations ranging from mild stenosis to frank obstruction. Enlargement of surrounding vascular structures can cause significant extrinsic compression of airways leading to respiratory failure. Herein, we describe three cases at two institutions of airway obstruction from vascular anomalies with resultant respiratory failure. In all 3 cases, endobronchial stenting allowed for liberation from mechanical ventilation (MV).
CASE PRESENTATION: 1: 75yo s/p CABG complicated by respiratory failure requires tracheostomy. There is recurrent respiratory failure and left lower lobe (LLL) collapse when not on MV. Bronchoscopy demonstrates severe extrinsic compression of the left mainstem bronchus (LMSB). Chest CT notes a descending thoracic aneurysm with retained plaque resulting in mass effect on the LMSB. A tubular silicone stent is deployed to the LMSB restoring airway patency and allowing liberation from MV. 2: 63yo with congenital aortic stenosis s/p repair for ruptured aortic aneurysm complicated by respiratory failure. Chest CT notes retained aneurysmal clot and resultant distal trachea and LMSB obstruction. A silicone Y-stent is placed with significant improvement in patency. A tracheostomy is placed for airway protection but the patient is ultimately discharged without need for MV. 3: 50yo with Tetralogy of Fallot s/p childhood repair fails to wean from MV after an elective hip replacement. Chest CT finds LMSB compression due to an enlarged left pulmonary artery aneurysm. Pulmonary artery plication is unsuccessful. A silicone Y-stent is ultimately placed with successful extubation, thereafter.
DISCUSSION: Endobronchial stenting is an accepted modality utilized in central airway obstruction. Respiratory failure due to extrinsic compression from vascular deformities has been described rarely, and as such, there exists no defined treatment formulae. We describe 3 cases of respiratory failure secondary to vascular compression in which further surgical and/or endovascular repair was deemed not an option. All cases were successfully treated with airway stenting.
CONCLUSIONS: Our experience suggests that endobronchial stenting is a viable modality for the treatment of airway obstruction secondary to vascular compression and can lead to resolution of respiratory failure.
Reference #1: Successful endobronchial stenting for bronchial compression from a massive thoracic aortic aneurysm. Comer D, Bedi A, et al. J Surg Case Rep. 2010 Jun; 2010(4): 2.
DISCLOSURE: The following authors have nothing to disclose: Jey Chung, Adnan Majid, Santacruz Jose, Scott Oh, Bryan Husta, Erik Folch
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