Tracheal Granulation Treated by Brachiocephalic Artery Transection and Laser Ablation: A Case Report

Abstract

A 15-year-old male patient with cerebral palsy, who underwent tracheal intubation for airway management due to pneumonia, developed granulation, and ventilation difficulties prevented his weaning from a respirator. Contrast-enhanced chest computed tomography (CT) showed that the brachiocephalic artery was pressing on the trachea, and that the granulation had narrowed the airway lumen. The patient was referred to our hospital owing to difficulty in extubation and the high risk of tracheo-brachiocephalic artery fistula. After confirmation of the presence of the Willis artery ring by head contrast-enhanced CT, the patient underwent brachiocephalic artery transection and tracheotomy. Although the clinical features of the patient’s condition improved postoperatively, the granulation severity gradually increased every 2 weeks after surgery and the granulation further narrowed the airway lumen. Laser ablation was performed 49 days after surgery and the granulation resolved. Brachiocephalic artery resection does not only reduce the risk of tracheo-brachiocephalic artery fistula but is also advantageous when performing laser ablation.