Successful Treatment of Tracheoinnominate Artery Fistula Following Tracheostomy in a Patient with Cerebrovascular Disease

Abstract

Tracheoinnominate artery fistula is a critical complication of tracheostomy. The most important factors influencing patient outcome are prompt diagnosis, immediate control of bleeding with a patent airway, and emergency operation with or without interruption of the innominate artery. Here, we report a case of tracheoinnominate artery fistula in a 40-year-old woman with cerebrovascular accident who was successfully managed with an aorta-axillary artery bypass.

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

“…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. 10,11) Our patient developed TIF more than 12 years after tracheostomy; the slide tracheoplasty performed 2 years ago might have changed the anatomy of innominate artery relative to trachea and the chronic mycobacterial tracheobronchitis might have contributed to the gradual necrosis and structural change of trachea, eventually led to this episode of near fatal event.…”

Combined tracheoinnominate artery fistula and tracheoesophageal fistula: A very rare complication of indwelling tracheostomy tube

“…The usual presentation of TIF is mild bleeding followed by massive hemorrhage; however, the massive bleeding from TIF can happen suddenly. [ 1 ] The presentation of TIF in our patient was sudden massive bleeding. Different factors are associated with compression of the innominate artery against the trachea leading to TIF.…”

“…Tracheoinnominate artery fistula (TIF) is a rare complication and is observed in less than 1% of patients after tracheostomy. [ 1 ]…”

Tracheoinnominate Fistula: Acute Bleeding and Hypovolemic Shock Due to a Trachea-Innominate Artery Fistula After Long-Term Tracheostomy, Treated With a Stent-Graft

“…The rapid management and the early control of the hemorrhage play a crucial role in patient survival (Seung et al 2012, Komatsu et al 2013. The primary goal is to secure the airway by hyperin ating the tracheal cuff and the advancement of the endotracheal tube.…”