UNUSUAL CAUSE OF LIFE-THREATENING RESPIRATORY DISTRESS FOLLOWING HYBRID TEVAR FOR DUCTAL AORTIC ARCH ANEURYSM- A RARE CASE REPORT
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Keywords
Ductal aortic aneurysm, hybrid TEVAR, vocal cord palsy, recurrent laryngeal nerve injury
Abstract
Hybrid TEVAR (Thoracic Endovascular Aortic Repair) is a recent technical advancement combining an interventional procedure along with an open surgical technique for avoiding risks of open surgical procedure and at the same time having the advantage of minimal intervention and enhanced recovery with optimisation of neck vessel revascularisation. We report a case of an elderly gentleman who presented with dyspnoea and hemoptysis. He was evaluated and diagnosed with an aortic arch aneurysm. He underwent hybrid TEVAR with open surgical carotico-carotid bypass followed by endovascular stent grafting of the aortic aneurysm. Patient had a preexisting left vocal cord palsy, probably due to Ortner’s / Cardio vocal syndrome. Post procedure, he developed life-threatening respiratory distress requiring reintubation. Symptoms improved within 48 hours, and extubated and discharged in stable condition. We present this case to highlight the possible factors responsible for transient vocal cord palsy in carotid surgical interventions and also the rare occurrence of bilateral vocal cord palsy resulting in life-threatening respiratory distress in the case of hybrid aortic interventions with undiagnosed unilateral vocal cord palsy, which necessitates preoperative video laryngoscopy evaluation for any patient planned for hybrid aortic interventions.
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