Emergent surgical treatment for acute thrombosis caused by pulmonary artery kinking after left upper sleeve lobectomy

Abstract

This is a report on the pulmonary arterioplasty for mechanical stenosis post-left upper sleeve lobectomy. A 64-year-old man had a tumour protruding into the left upper bronchus with a diagnosis of squamous cell carcinoma (cT1cN1M0). Left upper bronchial sleeve lobectomy was performed through posterolateral thoracotomy. On postoperative day 1, he received veno-arterial extracorporeal membrane oxygen support due to sudden pulseless electrical activity. We detected left pulmonary artery (PA) kinking with an impaired blood flow by using pulmonary angiography and immediately performed PA thrombectomy and arterioplasty using rethoracotomy. Following the en bloc removal of a thrombus that had completely occluded the left PA, the redundant PA was resected, and PA reconstruction was performed by direct end-to-end anastomosis. A postoperative contrast-enhanced computed tomography scan showed no signs of PA kinking and no residual thrombus formation. When PA bending and mechanical stenosis are detected after bronchial sleeve lobectomy, resection of the redundant PA is also required to prevent PA thrombosis.