Mediastinal bronchial artery aneurysm complicated with iatrogenic acute aortic dissection during bronchial artery embolization repaired with thoracic endovascular aortic repair: a case report

Abstract

Abstract Background Asymptomatic bronchial artery aneurysms (BAA) could be underdiagnosed, and the precise prevalence is unknown. Bronchial artery angiography revealed that this rare disease in about 1% of patients. BAA is fatal if ruptured since there is no correlation between the diameter and symptoms of the aneurysm and the risk of rupture. Early treatment on diagnosis is desirable. Bronchial artery embolization (BAE) is the first choice for treatment because of its minimally invasive nature. Case presentation A 74-year-old man was referred to our department and pointed out a tumor-like lesion under the aortic arch on a contrast-enhanced computed tomography (CECT). We diagnosed it as a mediastinal BAA, and BAE was planned. The bronchial artery arising from the aorta showed strong atherosclerotic meanders and was difficult to engage, resulting in iatrogenic acute aortic dissection (AAD). Urgent thoracic endovascular aortic repair (TEVAR) was performed. There was no contrast effect of the aneurysm on a postoperative CECT, indicating thrombotic occlusion. Conclusions We were preparing a system that could convert to surgery or TEVAR, in case of difficult to treat with BAE or ruptured aneurysm during BAE, so we were able to respond quickly to aortic dissection caused by BAE and obtain a good result of both BAA and aortic dissection. TEVAR would be considered a treatment of BAA, in cases such as the present case, where engagement is difficult, where the length of the inflow artery is short, or where the inflow artery is tortuous.