Rescue surgery for bronchial obstruction after endovascular thoracoabdominal stent implantation

A 63-year-old woman had a diagnosis of aneurysm of the arch and the descending aorta. Medical history included a Bentall procedure for aortic regurgitation and ascending aortic aneurysm in 2006. The patient underwent redo surgery owing to progression of the diameter of the aneurysm. Replacement of the arch by the frozen elephant trunk technique with implantation of an E-vita prosthesis (JOTEC GmbH, Hechingen, Germany) was performed. The procedure was completed with stent implantation (Valiant 42-200 mm; Medtronic, Inc, Minneapolis, Minn) in the descending aorta. On postoperative day 34 the patient had severe dyspnea. A bronchoscopic examination showed a significant decrease of left main bronchus diameter to less than 2 mm owing to exterior compression. Computed tomography (CT) revealed a large hematoma around the endoprosthesis ranging from the distal part of the subclavian artery to the diaphragm (Figures 1 and 2). After an interdisciplinary discussion of the therapeutic options, the decision for surgery over bronchial stenting was made. Surgerywas performedwith the patient in a right-sided position through a left minithoracotomy in the third intercostal space. Intraoperatively, a large and heavily tensioned aneurysmal sac of the descending aorta surrounding the E-vita prosthesis was opened with subsequent removal of the hematoma. The aneurysmal sac was left open to prevent development of subsequent hematoma.Multiple drainswere inserted. The postoperative course was uneventful with rapid respiratory weaning and the patient was discharged free of symptoms. Follow-up CT and bronchoscopy 1 month later showed a normal bronchus diameter.