Airway management in vascular central airway obstruction: a literature review

Vascular central airway obstruction (CAO) is a rare cause of upper airway obstruction in adults. CAO occurs below the level where it is invisible in a laryngoscope. Doctors therefore should pay attention to the possibilities of vascular CAO when attempting to prevent and resolve catastrophic complications from upper airway obstruction such as cardiorespiratory collapse and hemoptysis, which requires a thoughtful preoperative planning of airway management before starting a surgical reconstruction.

Aneurysm; Aortic arch; Pulmonary artery; Difficult airway; Vascular rings

[1] Oberg C, Holden V, Channick C. Benign central airway obstruction. Seminars in Respiratory and Critical Care Medicine. 2018; 39: 731–746.

[2] Yoshida T, Konno S, Takahashi A, Nasuhara Y, Betsuyaku T, Nishimura M. Flow-volume curve as an aid to diagnosis in double aortic arch masquerading as asthma in a young adult. Nihon Kokyuki Gakkai Zasshi. 2010; 48: 229–234.

[3] Sidney SB, Henning AG. Upper airway obstruction. In Alfred PF, Jack AE, Jay AF, Michael AG, Larry RK, Robert MS (eds.) Fishman’s pulmonary diseases and disorders (pp. 783–801). 3rd edn. New York: McGraw-Hill. 1998.

[4] Cook TM, MacDougall-Davis SR. Complications and failure of airway management. British Journal of Anaesthesia. 2012; 109: i68–i85.

[5] Hegewald M, Linares-Perdomo O, Collingridge D, Jensen R, Hankinson J, Morris A. Mortality and classification of airway obstruction severity by different methods. European Respiratory Journal. 2016; 48: PA1328.

[6] Murgu SD, Egressy K, Laxmanan B, Doblare G, Ortiz-Comino R, Hogarth DK. Central airway obstruction: benign strictures, tracheobron-chomalacia, and malignancy-related obstruction. Chest. 2016; 150: 426–441.

[7] McPherson K, Stephens RC. Managing airway obstruction. British Journal of Hospital Medicine. 2012; 73: C156–C160.

[8] Holden VK, Channick CL. Management of benign central airway obstruction. AME Medical Journal. 2018; 3: 76.

[9] Hung S, Lai JC, Chang W, Ku H. Effects of age on emergency airway management. Signa Vitae. 2021; 17: 127–131.

[10] Liao E, Chang W, Yu C, Chau Y, Sun F, Lai W, et al. Predictors of difficult endotracheal intubation in the emergency department: a single-center pilot study. Signa Vitae. 2021; 17: 77–84.

[11] Lim H, Wang H, Hung S, Ku H. A dangerous cause of airway obstruction: deep neck infection. Signa Vitae. 2021; 17: 4–9.

[12] Barros Casas D, Fernández-Bussy S, Folch E, Flandes Aldeyturriaga J, Majid A. Non-malignant central airway obstruction. Archivos De Bronconeumología. 2014; 50: 345–354.

[13] Ernst A, Feller-Kopman D, Becker HD, Mehta AC. Central airway obstruction. American Journal of Respiratory and Critical Care Medicine. 2004; 169: 1278–1297.

[14] Kussman BD, Geva T, McGowan FX. Cardiovascular causes of airway compression. Pediatric Anesthesia. 2004; 14: 60–74.

[15] Yilmaz M, Ozkan M, Dogan R, Demircin M, Ersoy U, Boke E, et al. Vascular anomalies causing tracheoesophageal compression: a 20-year experience in diagnosis and management. Heart Surgery Forum. 2003; 6: 149–152.

[16] Ruzmetov M, Vijay P, Rodefeld MD, Turrentine MW, Brown JW. Follow-up of surgical correction of aortic arch anomalies causing tracheoesophageal compression: a 38-year single institution experience. Journal of Pediatric Surgery. 2009; 44: 1328–1332.

[17] Singhal M, Gupta P, Singh RS, Rohit MK, Sodhi KS, Khandelwal N. Cardiovascular causes of pediatric airway compression: a pictorial review. Current Problems in Diagnostic Radiology. 2015; 44: 505–510.

[18] Kanabuchi K, Noguchi N, Kondo T. Vascular tracheobronchial compres-sion syndrome in adults: a review. Tokai Journal of Experimental and Clinical Medicine. 2011; 36: 106–111.

[19] Tominaga R, Tanaka J, Kawachi Y, Yoshitoshi M, Kohno H, Shiki K, et al. Surgical treatment of respiratory insufficiency due to tracheobronchial compression by aneurysms of the ascending aorta and innominate artery. Journal of Cardiovascular Surgery. 1988; 29: 413–417.

[20] Constenla I, Alvarez B, Yugueros X, Fernandez E, Bofill R, Matas M. Innominate artery aneurysm with hemoptysis and airway compression in a patient with bovine aortic arch. Journal of Vascular Surgery. 2012; 56: 822–825.

[21] Yamashiro S, Nagano T, Kuniyoshi Y, Kise Y, Maeda T, Arakaki R. Endovascular repair of intrathoracic ruptured kommerell’s diverticulum. Asian Cardiovascular and Thoracic Annals. 2012; 20: 587–590.

[22] Chen C, Chang C, Huang H. kommerell diverticulum compressing the tracheobronchial tree and presenting as wheezing. American Journal of Respiratory and Critical Care Medicine. 2014; 190: e32–e33.

[23] Dinh K, Manuel L, Somers M, Vicaretti M. Vascular tracheobronchial compression syndrome secondary to contained ruptured thoracic aortic aneurysm. Journal of Surgical Case Reports. 2021; 2021: rjab147.

[24] van Son JAM, Julsrud PR, Hagler DJ, Sim EKW, Pairolero PC, Puga FJ, et al. Surgical treatment of vascular rings: the mayo clinic experience. Mayo Clinic Proceedings. 1993; 68: 1056–1063.

[25] Sebening C, Jakob H, Tochtermann U, Lange R, Vahl CF, Bodegom P, et al. Vascular tracheobronchial compression syndromes- experience in surgical treatment and literature review. Journal of Thoracic and Cardiovascular Surgery. 2000; 48: 164–174.

[26] Jung HJ, Kim JB, Im KS, Kim DJ, Lee JM. Management of tracheal compression that’s caused by an innominate artery aneurysm—a case report. Korean Journal of Anesthesiology. 2009; 57: 762.

[27] Kumar A, Raju S, Das A, Mehta AC. Vessels of the central airways. Chest. 2016; 149: 869–881.

[28] Anastasius EJ, Sawali H. Stridor in a newborn with double aortic arch- a case report. Iranian Journal of Otorhinolaryngology. 2019; 31: 61–63.

[29] ŠKarić I, Jakobović J, Ilić MK, KondžA K, Babić I. Variation of vascular ring as a cause of extubation failure. Signa Vitae. 2008; 3: 29–31.

[30] Mclaughlin RB, Wetmore RF, Tavill MA, Gaynor JW, Spray TL. Vascular anomalies causing symptomatic tracheobronchial compression. laryngoscope. 1999; 109: 312–319.

[31] Zheng GM, Wu XH, Tang LF. Respiratory symptoms due to vascular ring in children. Hong Kong Journal of Paediatrics. 2016; 21: 14–21.

[32] Lanjewar C, Shiradkar S, Agrawal A, Mishra N, Kerkar P. Aneurysmally dilated major aorto-pulmonary collateral in tetralogy of Fallot. Indian Heart Journal. 2012; 64: 196–197.

[33] Miyamoto Y, Ohashi A, Ishi H, Tazaki G, Kondo T. A case of severe bronchial stenosis caused by a vascular ring in an elderly woman. Nihon Kokyuki Gakkai Zasshi. 2008; 46: 243–247.

[34] Ochi N, Yasugi M, Takigawa N. Asymptomatic double aortic arch with compressed oesophagus in an adult. Case Reports. 2012; 2012: bcr1220115315.

[35] Smith BM, Lu JC, Dorfman AL, Ghadimi Mahani M, Agarwal PP. Rings and slings revisited. Magnetic Resonance Imaging Clinics of North America. 2015; 23: 127–135.

[36] van Son JAM, Julsrud PR, Hagler DJ, Sim EKW, Puga FJ, Schaff HV, et al. Imaging strategies for vascular rings. the Annals of Thoracic Surgery. 1994; 57: 604–610.

[37] Polguj M, Chrzanowski L, Kasprzak JD, Stefańczyk L, Topol M, Majos A. The aberrant right subclavian artery (arteria lusoria): the morphological and clinical aspects of one of the most important variations—a systematic study of 141 reports. Scientific World Journal. 2014; 2014: 292734.

[38] Mossad E, Farid I, Youssef G, Ando M. Diverticulum of kommerell: a review of a series and a report of a case with tracheal deviation compromising single lung ventilation. Anesthesia & Analgesia. 2002; 94: 1462–1464.

[39] Prieto Lastra L, Pérez Pimiento A, González Sánchez LA, Rodríguez Mosquera M, García Cubero A. Be sure you are treating asthma. Allergologia et Immunopathologia. 2006; 34: 127–128.

[40] Choi J, Min KH, Lee SY, Kang KH, Shim JJ. Rare adult presentation of fixed airways obstruction: remember aortic arch abnormalities. Thorax. 2018; 73: 298–299.

[41] Swami N, Koshy G, Jamal M, Abdulla TS, Alkhulaifi A. Typical asthmatic presentation of congenital vascular ring can masquerade a general physician. Case Reports in Vascular Medicine. 2013; 2013: 1–4.

[42] van Rosendael PJ, Stoger JL, Kies P, Vliegen HW, Hazekamp MG, Koolbergen DR, et al. The clinical spectrum of kommerell’s diverticulum in adults with a right-sided aortic arch: A case series and literature overview. Journal of Cardiovascular Development and Disease. 2021; 8: 25.

[43] Jung JY, Almond CH, Saab SB, Lababidi Z. Surgical repair of right aortic arch with aberrant left subclavian artery and left ligamentum arteriosum. Journal of Thoracic and Cardiovascular Surgery. 1978; 75: 237–243.

[44] Bell KT, McKinney MR, Salazar PA, Esper E. Hybrid repair of an adult with a double aortic arch, coarctation of the aorta, and left subclavian artery aneurysm. Journal of Vascular Surgery Cases and Innovative Techniques. 2019; 5: 535–537.

[45] Sumerkan MC, Helvaci F, Basak M. Double aortic arch associated with tracheal and esophageal compression in an adult. Anatolian Journal of Cardiology. 2014; 14: E14–E15.

[46] Generali T. Double aortic arch determining tracheal stenosis in an adult: erratum. Asian Cardiovascular and Thoracic Annals. 2014; 22: 884–884.

[47] Seo HS, Park YH, Lee JH, Hur SC, Ko YJ, Park SY, et al. A case of balanced type double aortic arch diagnosed incidentally by transthoracic echocardiography in an asymptomatic adult patient. Journal of Cardiovascular Ultrasound. 2011; 19: 163–166.

[48] Kypson AP, Anderson CA, Rodriguez E, Koutlas TC. Double aortic arch in an adult undergoing coronary bypass surgery: a therapeutic dilemma?European Journal of Cardio-Thoracic Surgery. 2008; 34: 920–921.

[49] Geva T, Ray RA, Santini F, Van Praagh S, Van Praagh R. Asymptomatic persistent fifth aortic arch (congenital double-lumen aortic arch) in an adult. American Journal of Cardiology. 1990; 65: 1406–1407.

[50] Kron IL, Mappin G, Nolan SP, Kellum C, Tegtmeyer CJ. Symptomatic double aortic arch causing tracheal and esophageal compression in the adult. Annals of Thoracic Surgery. 1987; 43: 105–106.

[51] Calabrese C, Corcione N, Di Spirito V, Guarino C, Rossi G, Domenico Gargiulo G, et al. Recurrent respiratory infections caused by a double aortic arch: the diagnostic role of spirometry. Respiratory Medicine Case Reports. 2013; 8: 47–50.

[52] Piloni D, Tirelli C, Domenica RD, Conio V, Grosso A, Ronzoni V, et al. Asthma-like symptoms: is it always a pulmonary issue?Multidisciplinary Respiratory Medicine. 2018; 13: 21.

[53] Fenández-Tena A, Martínez-González C. Double aortic arch diagnosed in a 44-year-old woman with recurring respiratory infections. Respiratory Medicine Case Reports. 2017; 20: 176–178.

[54] Barbara DW, Broski SM, Patch RK, Pochettino A. Double aortic arch causing severe tracheal compression. Anesthesiology. 2017; 126: 326.

[55] Olearchyk AS. Right-Sided double aortic arch in an adult. Journal of Cardiac Surgery. 2004; 19: 248–251.

[56] LaBelle MF, Rainer WG, Ratzer E, Miller KB. Surgical repair of pulmonary artery sling in an adult. Annals of Thoracic Surgery. 2010; 90: 1009–1011.

[57] Imoto S, Satomi R, Watase M, So M, Murakami H, Hosoo S, et al. An adult case of pulmonary artery sling accompanied by tracheobronchoma-lacia. Internal Medicine. 2019; 58: 1621–1624.

[58] Inui T, Yamada H, Hida N, Terashima H, Saito T, Hizawa N. A case of a pulmonary artery sling misdiagnosed as refractory asthma for 20 years. Clinical Case Reports. 2017; 5: 863–866.

[59] Karthekeyan BR, Sundar S, Rao S, Vakamudi M. Management of a patient with kommerrell’s aneurysm causing tracheal and esophageal compression. Indian Journal of Anaesthesia. 2009; 53: 358–361.

[60] Tsukui H, Aomi S, Yamazaki K. Surgical strategy for kommerell’s diver-ticulum: total arch replacement. Journal of Thoracic and Cardiovascular Surgery. 2014; 148: 1423–1427.

[61] Hindori VG, Schepens MA. Tracheal compression due to a kommerell diverticulum in a patient with a right-sided aorta. Nederlands Tijdschrift voor Geneeskunde. 2006; 150: 554–558.

[62] Takahashi Y, Tsutsumi Y, Monta O, Ohashi H. Severe tracheal compression due to cervical aortic arch aneurysm. Journal of Cardiac Surgery. 2011; 26: 400–402.

[63] Bagozzi L, Bottio T, Rubino M, Gerosa G. Frozen elephant trunk to exclude the kommerell diverticulum associated with double aortic arch in adult redo patient. Annals of Vascular Surgery. 2021; 73: 529–531.

[64] Altinsoy B, Altintas N, Unver E. Photoclinic. Central airway obstruction due to right aortic arch anomaly. Archives of Iranian Medicine. 2013; 16: 197–198.

[65] Gupta K, Tyagi D, Prajapat D, Kumar V. Tracheal compression due to anomalous innominate artery in an adult. Lung India. 2014; 31: 419–420.

[66] Tramper J, Noordegraaf AV, Meijboom LJ, Zwitserloot AM, Straver B, Aman J. A rare hemodynamic cause of airway obstruction. American Journal of Respiratory and Critical Care Medicine. 2018; 197: e20–e21.

[67] Tadavarthy SM, Castaneda-Zuniga WR, Klugman J, Ben Shachar J, Amplatz K. Syphilitic aneurysms of the innominate artery. Radiology. 1981; 139: 31–34.

[68] Brewster DC, Moncure AC, Darling RC, Ambrosino JJ, Abbott WM. Innominate artery lesions: problems encountered and lessons learned. Journal of Vascular Surgery. 1985; 2: 99–112.

[69] Schumacher PD, Wright CB. Management of of arteriosclerotic aneurysm of the innominate artery. Surgery. 1979; 85: 489–495.

[70] Sayed A, Farok A, El-Sayed H, Soliman SA. Pulsating suprasternal lump: a diagnostic and management dilemma. Methodist DeBakey Cardiovascular Journal. 2013; 9: 233–234.

[71] Soylu E, Harling L, Ashrafian H, Anagnostakou V, Tassopoulos D, Charitos C, et al. Surgical treatment of innominate artery and aortic aneurysm: a case report and review of the literature. Journal of Cardiothoracic Surgery. 2013; 8: 141.

[72] Inoue O, Murai H, Kaneko S, Usui S, Furusho H, Takamura M. Hemodynamic collapse induced by general anesthesia in a patient with an unruptured thoracic aortic aneurysm: a case report. BMC Cardiovascular Disorders. 2013; 13: 122.

[73] Kumeda H, Tomita Y, Morita S, Yasui H. Compression of trachea and left main bronchus by arch aneurysm. Annals of Thoracic Surgery. 2005; 79: 1038–1040.

[74] Lefrak EA, Stevens PM, Howell JF. Respiratory insufficiency due to tracheal compression by an aneurysm of the ascending, transverse, and descending thoracic aorta. Journal of Thoracic and Cardiovascular Surgery. 1972; 63: 956–961.

[75] Chen W, Tu C, Liang S, Liu J, Chen W. Metallic stents for rescuing a patient with severe upper airway compression due to aortic aneurysm. American Journal of Emergency Medicine. 2009; 27: 256.e1–256.e4.

[76] Kumar A, Dutta V, Negi S, Puri G. Vascular airway compression management in a case of aortic arch and descending thoracic aortic aneurysm. Annals of Cardiac Anaesthesia. 2016; 19: 568–571.

[77] Dutau H, Cavailles A, Fernandez-Navamuel I, Breen DP. Tracheal com-pression in a patient with marfan’s syndrome-associated tracheomegaly treated by an xxl stent: the largest diameter airway stent ever placed in a previously undescribed airway condition. Respiration. 2009; 77: 97–101.

[78] Takara I, Uehara M, Higa Y, Takechi A, Iha H, Sugahara K. Respiratory management in a patient with severe tracheal stenosis caused by compression from the ascending aortic arch aneurysm. Masui. 2003; 52: 1079–1082.

[79] de Feiter PW, van Mook WNKA, Jacobs MJHM. Tracheal compression caused by an innominate artery aneurysm after thoracic aortic aneurysm repair in a patient with Marfan disease. Journal of Thoracic and Cardiovascular Surgery. 2005; 129: 943–944.

[80] Odofin X, Houbby N, Hagana A, Nasser I, Ahmed A, Harky A. Thoracic aortic aneurysms in patients with heritable connective tissue disease. Journal of Cardiac Surgery. 2021; 36: 1083–1090.

[81] Heuts S, Sprooten RTM, Heines SJH, Mees BME. Mechanical ventilation variability due to tracheal compression in a patient with a mycotic descending aortic aneurysm: an inverse correlation with blood pressure. European Journal of Cardiothoracic Surgery. 2020; 58: 864–866.

[82] Jung H, Do YW, Lee SY, Lee Y, Oh TH, Kim GJ. Thoracic aortic aneurysms exerting high extrinsic pressure on the airway. Journal of Cardiothoracic Surgery. 2019; 14: 169.

[83] Comer D, Bedi A, Kennedy P, McManus K, McIlwaine W. Successful endobronchial stenting for bronchial compression from a massive thoracic aortic aneurysm. Journal of Surgical Case Reports. 2010; 2010: 2.

[84] Abdulghani A, Pisipati S, Mcwilliams R, Page R. Aorto-bronchial fistula following aortic and bronchial stenting of a thoracic aneurysm. European Journal of Cardiothoracic Surgery. 2006; 29: 419–421.

[85] Masumoto H, Shimamoto M, Yamazaki F, Nakai M, Fujita S, Miura Y. Airway stenosis associated with a mycotic pseudoaneurysm of the common carotid artery. General Thoracic and Cardiovascular Surgery. 2008; 56: 242–245.

[86] Lee S, Wu K, Chen P, Sheu C, Kuo C, Wang T, et al. Intrathoracic tracheal obstruction caused by a carotid mycotic aneurysm in a patient with deep neck infection—a case report. Respiration. 2007; 74: 220–223.

[87] Lacey L, Dabbas N, Saker R, Blakeley C. Dissection of the carotid artery as a cause of fatal airway obstruction. Emergency Medicine Journal. 2007; 24: 367–368.

[88] Waikittipong S. Syphilitic aortic aneurysm presenting with upper airway obstruction. Asian Cardiovascular and Thoracic Annals. 2012; 20: 575–577.

[89] Katayama Y, Suzuki H, Mizutani T. Aorto-bronchial fistula after implantation of a self-expanding bronchial stent in a patient with aortic dissection. Japanese Journal of Thoracic and Cardiovascular Surgery. 2000; 48: 73–75.

[90] Nagato H, Nishiwaki N, Kaneda K, Tamura N. Surgical repair of a giant pulmonary artery aneurysm that caused severe left bronchial obstruction. Interactive Cardiovascular and Thoracic Surgery. 2020; 31: 266–267.

[91] Park HS, Chamarthy MR, Lamus D, Saboo SS, Sutphin PD, Kalva SP. Pulmonary artery aneurysms: diagnosis & endovascular therapy. Cardiovascular Diagnosis and Therapy. 2018; 8: 350–361.

[92] Jaijee SK, Ariff B, Howard L, O’Regan DP, Gin-Sing W, Davies R, et al. Left main bronchus compression due to main pulmonary artery dilatation in pulmonary hypertension: two case reports. Pulmonary Circulation. 2015; 5: 723–725.

[93] Morjaria S, Grinnan D, Voelkel N. Massive dilatation of the pulmonary artery in association with pulmonic stenosis and pulmonary hypertension. Pulmonary Circulation. 2012; 2: 256–257.

[94] Achouh L, Montani D, Garcia G, Jais X, Hamid AM, Mercier O, et al. Pulmonary arterial hypertension masquerading as severe refractory asthma. European Respiratory Journal. 2008; 32: 513–516.

[95] Yokota T, Asai T, Okuda Y. Use of the I-gel for tracheostomy in a patient with neck deformity and tracheal stenosis. Masui. 2015; 64: 307–309.

[96] Kolilekas L, Manali E, Kalomenidis I, Mouchtouri E, Spyrou K, Papiris S. Tracheal compression in marfan syndrome. Internal Medicine. 2008; 47: 1069–1070.

[97] Nagahiro I, Toda D, Andou A, Shimizu N. A case of bronchial varices due to extrahepatic portal hypertension. Respiration. 2007; 74: 460–461.

[98] Desai AD, Bandi V, Holzhauser L, Loebe M, Noon G, Lunn W. Bleeding after biopsy of a bronchial artery arteriovenous malformation presenting as an endobronchial mass. Journal of Bronchology. 2008; 15: 176–178.

[99] Soda H, Oka M, Kohno S, Watanabe M, Takatani H, Hara K. Arteri-ovenous malformation of the bronchial artery showing endobronchial protrusion. Internal Medicine. 1995; 34: 797–800.

[100] Arango Tomás E, Cerezo Madueño F, Salvatierra Velázquez A. Bronchiectasis due to pulmonary artery aneurysm. Interactive CardioVas-cular and Thoracic Surgery. 2013; 17: 176–178.

[101] Padrones SS, Lisbona RL, Gratacos AR, Rodriguez AN, Diaz-Jimenez JP. Pulmonary artery pseudoaneurysm arising from a lung tumor. Journal of Bronchology & Interventional Pulmonology. 2009; 16: 274–276.

[102] Dransfield MT, Johnson JE. A mycotic pulmonary artery aneurysm presenting as an endobronchial mass. Chest. 2003; 124: 1610–1612.

[103] Shweihat YR, Zoby MAL. Pulmonary varices in an adult. Journal of Bronchology & Interventional Pulmonology. 2015; 22: 326–328.

[104] Walker CM, Rosado-de-Christenson ML, Martínez-Jiménez S, Kunin JR, Wible BC. Bronchial arteries: anatomy, function, hypertrophy, and anomalies. RadioGraphics. 2015; 35: 32–49.

[105] Kobayashi H, Kanoh S, Motoyoshi K, Ozeki Y, Aida S. Bulging endobronchial varices associated with bronchial artery aneurysm. Journal of Bronchology. 2008; 15: 52–53.

[106] Carden KA, Boiselle PM, Waltz DA, Ernst A. Tracheomalacia and tracheobronchomalacia in children and adults. Chest. 2005; 127: 984–1005.

[107] Reddel HK, Taylor DR, Bateman ED, Boulet L, Boushey HA, Busse WW, et al. An official american thoracic society/european respiratory society statement: asthma control and exacerbations. American Journal of Respiratory and Critical Care Medicine. 2009; 180: 59–99.

[108] Gibbs PM, Hami A. Pulmonary arterial aneurysm presenting as an endobronchial mass. Thorax. 1995; 50: 1013–1017.

[109] Sharma S, Hashmi MF, Burns B. Alveolar gas equation. Treasure Island: Statpearls. 2021.

[110] Grosu HB, Eapen GA, Morice RC, Jimenez CA, Casal RF, Almeida FA, et al. Stents are associated with increased risk of respiratory infections in patients undergoing airway interventions for malignant airways disease. Chest. 2013; 144: 441–449.

[111] Ost DE, Shah AM, Lei X, Godoy MCB, Jimenez CA, Eapen GA, et al. Respiratory infections increase the risk of granulation tissue formation following airway stenting in patients with malignant airway obstruction. Chest. 2012; 141: 1473–1481.

[112] Wadsworth SJ, Juniper MC, Benson MK, Gleeson FV. Fatal com-plication of an expandable metallic bronchial stent. British Journal of Radiology. 1999; 72: 706–708.

[113] Nouraei SM, Pillay T, Hilton CJ. Emergency management of aorto-bronchial fistula after implantation of a self-expanding bronchial stent. European Journal of Cardiothoracic Surgery. 2001; 20: 642–644.

[114] Madden BP, Loke T, Sheth AC. Do expandable metallic airway stents have a role in the management of patients with benign tracheobronchial disease? Annals of Thoracic Surgery. 2006; 82: 274–278.

[115] Watanabe S, Toyohira H, Yamaoka A, Yotsumoto G, Shiota K, Taira A. Usefulness of dumon-type endotracheal stent for left main bronchial obstruction caused by thoracic aortic aneurysm—a case report. Nihon Kyobu Geka Gakkai Zasshi. 1996; 44: 1776–1780.

[116] Kawano H, Manabe S, Takata K, Soga T, Tomiyama Y, Oshita S. Anesthesia for a patient with severe tracheal stenosis due to thoracic aortic aneurysm. Masui. 2011; 60: 1195–1198.

[117] Awasthy N, Arora HS, Radhakrishnan S. Endotracheal tube as tracheal stent in vascular ring. Asian Cardiovascular and Thoracic Annals. 2016; 24: 195–197.

[118] Saito K, Sunouchi A, Toyama H, Yamauchi M. Preoperative assessment of airway patency during general anesthesia in a patient with severe tra-cheal stenosis: effectiveness of noninvasive positive pressure ventilation. Journal of Cardiothoracic and Vascular Anesthesia. 2020; 34: 566–567.

[119] Yeap TB, Teah MK, Ramly AKM, Bong CP. Anaesthetic challenges for a patient with huge superior mediastinal mass in prone position. BMJ Case Reports. 2021; 14: e242118.

[120] Béchard P, Létourneau L, Lacasse Y, Côté D, Bussières J. Perioperative cardiorespiratory complications in adults with mediastinal mass. Anes-thesiology. 2004; 100: 826–834.

[121] Bauchmuller K, Glossop A. Non-invasive ventilation in the periopera-tive period. BJA Education. 2016; 16: 299–304.

[122] Jokinen K, Palva T, Sutinen S, Nuutinen J. Acquired tracheobronchoma-lacia. Annals of Clinical Research. 1977; 9: 52–57.

[123] Majid A, Gaurav K, Sanchez JM, Berger RL, Folch E, Fernandez-Bussy S, et al. Evaluation of tracheobronchomalacia by dynamic flexible bronchoscopy. A pilot study. Annals of the American Thoracic Society. 2014; 11: 951–955.

[124] Matsushita T, Nakamura A, Kawachi H, Hashimoto T, Nakaji S. A case report of surgical treatment for aneurysm of the brachiocephalic artery associated with tracheal stenosis. Nihon Kyobu Geka Gakkai Zasshi. 1997; 45: 754–758.

[125] Totaro P, Marconi S, Morganti S, Corsico AG, Pelenghi S, Auricchio F. Multidisciplinary preoperative simulations to optimize surgical outcomes in a challenging case of the complete double aortic arch in the adult. Journal of Cardiac Surgery. 2020; 35: 716–720.