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J Thorac Cardiovasc Surg 2005;129:1436-1438
© 2005 The American Association for Thoracic Surgery

Brief Communication

Multistep endobronchial-endovascular approach in recurrent acute respiratory failure caused by thoracic aneurysm

Sandro Gelsomino, MDa,*, Stefano Romagnoli, MDa, Alberto Dragotto, MDb, Massimo Cassai, MDa, Brenno Fiorani, MDa, Carlo Sorbara, MDa, Pierluigi Stefàno, MDa

a Cardiovascular Anaesthesia and Cardiac Surgery Unit, Careggi Hospital, Florence, Italy.
b Thoracic Surgery Unit, Careggi Hospital, Florence, Italy.

Received for publication August 3, 2004; revisions received August 19, 2004; accepted for publication September 7, 2004.

* Address for reprints: Sandro Gelsomino, MD, Segreteria Cardiochirurgia, Careggi Hospital, Viale Morgagni 85, 50134, Florence, Italy (Email: sandrogelsomino@virgilio.it).

The first 20% of the full text of this article appears below.


Figure 1
Gelsomino and Romagnoli


In recent years, the placement of endovascular stent-graft prostheses has gained increasing popularity as a low-risk, less-invasive, and less-traumatic procedure for thoracic aortic aneurysm (TAA) compared with traditional surgical intervention.1 Similarly, technical developments have facilitated stent implantation to restore airway patency in patients with airway obstruction.2

We describe a case of recurrent respiratory insufficiency caused by compression of the tracheobronchial tree by an extensive TAA in which we used a multistep endobronchial-endovascular technique.

Clinical Summary

A 78-year-old man with a history of TAA was admitted to the emergency department because of recurrence of respiratory failure. He was unconscious, with cyanosis and severe hypertension (220/120 mm Hg). On thoracic examination, wheezes were heard at the lower third of the left lung. Arterial blood gas analysis revealed an arterial oxygen partial pressure of 40 mm Hg, a carbon dioxide partial pressure of 120 mm Hg, and a pH value of 6.93. The patient was intubated and mechanically ventilated. Preoperative chest radiography and computed tomography showed a large aortic aneurysm with compression of the tracheobronchial tree (Figure 1). Fiberoptic bronchoscopy confirmed extrinsic compression of the trachea just proximal to the carina and a significant narrowing of . . . [Full Text of this Article]






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