Endovascular stenting of tracheoinnominate fistula after tracheostomy in a 14-year-old boy

Bae, Mi-Hye; Lee, Yun-Jin; Nam, Sang Ook; Kim, Hye-Young; Kim, Chang Won; Kim, Young Mi

doi:10.3345/kjp.2016.59.11.s76

Cited by 6 publications

(7 citation statements)

References 16 publications

(24 reference statements)

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“…This is consistent with the increasing number of tracheotomies performed for children with chronic neurological conditions . We postulate that this increased risk is the result of excessive patient movement and long‐term mechanical ventilation, which have been implicated in TIF formation . Ventilator support often requires a closed circuit, necessitating prolonged periods of local pressure of the tracheostomy tube itself or the cuff on the tracheal wall.…”

Section: Discussionsupporting

confidence: 66%

“…The observed unweighted kappa for full‐text reviewing between the two independent reviewers was 0.802 (95% confidence interval (CI) 0.752–0.852). Fifty‐four publications were included in final synthesis, including 40 case reports and 14 case series, which were published between 1948 and 2017 . Studies from the United States were the most common (33.3%), followed by those from Japan (27.8%) (Supporting Appendix 2).…”

Section: Resultsmentioning

confidence: 99%

“…With the lack of comparison groups in case series and case studies, we were unable to compare risk factors between patients who developed TIF and patients who did not among those who underwent tracheotomy. Commonly cited risk factors of TIF development include position of the tracheotomy tube and high‐riding innominate arteries . In our review, we identified 77 TIF cases.…”

Section: Discussionmentioning

confidence: 99%

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Tracheo‐innominate fistula in children: A systematic review of literature

et al. 2019

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Objective: Tracheo-innominate fistula (TIF) is a rare but fatal complication of tracheotomy. To date, there is a paucity of literature regarding pediatric TIFs. The objectives of this study were to conduct a systematic review of literature on pediatric TIF following tracheotomy and describe three demonstrative cases from our institutional experience.Methods: We conducted a systematic review using MEDLINE, Embase, Cochrane Database of Systematic Reviews, Web of Science, and CINAHL. All studies with pediatric patients (under 18 years of age) who developed TIF following tracheotomy were included.Results: Fifty-four publications met inclusion criteria, reporting on 77 cases. The most common indication for tracheotomy was prolonged intubation and the need for ventilatory support (38.6%), with neurological comorbidities being the most common indication (72.7%). The mean time to TIF was 395.7 days (95% confidence interval, 225.9-565.5). Fifty-four patients (70.1%) presented with massive hemorrhage, whereas 18 patients (23.3%) presented with a sentinel bleeding event. The most common diagnostic interventions were computed tomography scan with or without contrast and bronchoscopy (55.8%). A substantial number of patients did not have any investigations (41.6%). Surgical management occurred in 70.1% of patients. Mortality was 38.6% in reported cases with variable follow-up periods.Conclusion: TIF may occur in long-term tracheostomy-dependent children, contrary to the conventionally described 3-week postoperative period. The mortality may not be as high as previously reported with timely intervention. Our results are limited by inherent risks of bias. Further research including well-designed cohort studies are needed to guide an evidencebased approach to TIF.

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Section: Discussionsupporting

confidence: 66%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Tracheo‐innominate fistula in children: A systematic review of literature

et al. 2019

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“…TIF often occurred within the first 3 weeks of tracheostomy creation, 4,5) but has been reported to occur long after the procedure, especially in patients with neuromuscular disorders. [6][7][8] Identified risk factors included tracheostomy below the fourth tracheal ring, 9) high located innominate artery, pressure necrosis of tracheal wall related to overinflated tracheostomy tube cuff, local infections, prolonged positive pressure ventilation, and spinal deformity.…”

Section: Discussionmentioning

confidence: 99%

Successful Rescue of a Ruptured Tracheoinnominate Fistula with Extracorporeal Membrane Oxygenation, Endovascular Stents, and Debranching Surgical Bypass

Chien

Chao²,

Lee

et al. 2020

ATCS

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We reported a case of ruptured tracheoinnominate fistula in a 14-year-old boy with history of repeated sternotomy. Tracheostomy was performed at age 2 years. Slide tracheoplasty was done at age 13 years. He presented to outpatient clinic with episodic hemosputum. Massive blood emanated from stoma during bronchoscopy evaluation. Venous-arterial extracorporeal membrane oxygenation was installed for resuscitation. A contrast-enhanced computed tomography (CT) and angiography confirmed the diagnosis. Immediate control of bleeding was achieved by an endovascular stent graft deployed at innominate artery. Massive hemorrhage recurred on day 7. An aortic arch stent was inserted and all arch vessels debranching via supraclavicular collar excision was performed. A covered stent was used to fenestrate the aortic stent and establish antegrade blood flow to all neck vessels via left common carotid artery. The patient remained stable at 10-month follow-up. Combination of extracorporeal membrane oxygenation, endovascular intervention, and surgical bypass could be effective in treating critical patients.

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“…5 Further reports have continued to use stent grafting as the treatment choice in children with success and known stable outcomes at several weeks to 24 months after the procedure. [6][7][8] Endovascular treatment was pursued after the patient recurred postsurgical repair as repeat surgical exploration was considered to carry unacceptable risks. The endovascular approach allows rapid control of bleeding while avoiding the morbidity of a median sternotomy, and we speculate a more favorable course had the patient been treated primarily in this manner.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Stent Graft Exclusion of an Iatrogenic Tracheoinnominate Fistula after Unsuccessful Surgical Repair

Woerner

Koo

Monroe

2018

J Clin Interv Radiol ISVIR

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A 10-year-old girl with metachromatic leukodystrophy developed a tracheoinnominate artery fistula and massive hemoptysis following tracheostomy, initially requiring open surgical repair. Massive hemoptysis recurred at 1 month due to suspected pericardial patch dehiscence. The authors herein describe the subsequent emergent treatment by stent graft exclusion and review the existing literature surrounding this rare and potentially fatal condition. AbstractKeywords ► pseudoaneurysm ► innominate artery ► stent

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Endovascular stenting of tracheoinnominate fistula after tracheostomy in a 14-year-old boy

Cited by 6 publications

References 16 publications

Tracheo‐innominate fistula in children: A systematic review of literature

Tracheo‐innominate fistula in children: A systematic review of literature

Successful Rescue of a Ruptured Tracheoinnominate Fistula with Extracorporeal Membrane Oxygenation, Endovascular Stents, and Debranching Surgical Bypass

Endovascular Stent Graft Exclusion of an Iatrogenic Tracheoinnominate Fistula after Unsuccessful Surgical Repair

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