Spontaneous Rupture of Subclavian Artery Branch Leads to Compromised Airway
Though rare, a spontaneous rupture of a branch of the left subclavian artery leading to a compromised airway requiring emergent intervention
by experienced staff can occur. In such cases, the expanding hematoma can cause tracheal deviation. Here we discuss the emergent airway management of such a case emphasizing the importance of early intervention by an experienced airway management team.
We present the case of a spontaneous rupture of a branch
of the left subclavian artery leading to a compromised airway
requiring emergent intervention by experienced staff. Such
causes of tracheal deviation are exceedingly rare, though
may become more common as people take antiplatelet drugs
as a means to prevent pathology induced clots.
A non-stridorous 60 year old male with past medical
history significant for myocardial infarction and multiple
strokes currently taking clopidogrel and rivaroxaban. While
intoxicated, he fell from a standing position and presented
to an outside hospital with neck pain and dyspnea. He was
found to have an expanding neck hematoma and was transferred to our tertiary care center where the hematoma was
clearly expanding further and causing impending airway
compromise. CT imaging demonstrated that the retropharyngeal hematoma was arising from a tear in a prevertebral artery arising from the left subclavian artery and causing tracheal deviation. The decision was made to perform
an awake, spontaneously breathing, fiberoptic intubation
to protect the airway so that the patient could undergo an
emergent embolization procedure.
Of 17 reported spontaneous ruptures of branches of the
subclavian artery1
, only 3 have been associated with dyspnea. Of the 2 reported deaths, one resulted from airway
compromise.2
Endovascular repair was performed on two
of these cases without complication. In the case presented
here, with the patient’s airway secured and appropriate anesthesia induced, successful repair of the ruptured vessel
was able to occur and the patient was admitted to the ICU
post-operatively for further management.
https://www.stephypublishers.com/sojmccr/pdf/SOJMCCR.MS.ID.000511.pdf
Comments
Post a Comment