Department of vascular surgery, Amsterdam UMC, 1209Location VU Medical Centre, Amsterdam, The Netherlands.
Department of vascular surgery, 1140Northwest Clinics, Alkmaar, The Netherlands.
Vasc Endovascular Surg. 2022 Jul;56(5):514-516. doi: 10.1177/15385744221085814. Epub 2022 Apr 1.
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.
一位 82 岁男性因严重呼吸窘迫被转至急诊部。计算机断层扫描血管造影显示降主动脉大破裂囊状动脉瘤导致气管受压。紧急进行了胸主动脉腔内修复术（TEVAR）。为了减少气管受压，放置了气管内支架（硅酮 Dumon）。手术后，呼吸功能得到改善。手术后两天，患者拒绝进一步的侵入性治疗，包括从气管内支架中机械吸痰，开始进行姑息性镇静治疗。减少囊状主动脉瘤对气管压迫的常规治疗是开放手术动脉瘤修复。如果由于患者年龄、合并症或动脉瘤破裂后出现严重血流动力学不稳定而不适合开放修复，放置气管内支架的 TEVAR 可作为减少气管压迫的确定性手术的桥梁。
