Tracheo-Innominate Artery Fistula After Tracheostomy

Kapural, Leonardo; Šprung, Juraj; Glunčić, Ivo; Kapural, Miranda; Andelinovic, Simon; Primorac, Dragan; Schoenwald, Peter K.

doi:10.1097/00000539-199904000-00018

Cited by 25 publications

(32 citation statements)

References 10 publications

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“…The pathophysiologic mechanism involves pressure necrosis of the tube tip or cuff with subsequent erosion of the anterior tracheal wall. 93 This erosion can cause a fistulous communication between the trachea and the innominate artery as it passes anteriorly across the trachea. The clinical presentation of tracheoinnominate artery fistula is classically described as a sentinel bleed followed by massive hemoptysis.…”

Section: Larynxmentioning

confidence: 99%

“…The clinical presentation of tracheoinnominate artery fistula is classically described as a sentinel bleed followed by massive hemoptysis. 93,94 Its diagnosis requires a high index of clinical suspicion because other diagnostic modalities, such as angiography, can delay management and lead to death. An immediate intervention that can be used to stop the bleeding is hyperinflation of the tracheotomy cuff.…”

Section: Larynxmentioning

confidence: 99%

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Complications of Airway ManagementDiscussion

Pacheco-Lopez¹,

Berkow

Hillel³

et al. 2014

Respir Care

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Although endotracheal intubation is commonly performed in the hospital setting, it is not without risk. In this article, we review the impact of endotracheal intubation on airway injury by describing the acute and long-term sequelae of each of the most commonly injured anatomic sites along the respiratory tract, including the nasal cavity, oral cavity, oropharynx, larynx, and trachea. Injuries covered include nasoseptal injury, tongue injury, dental injury, mucosal lacerations, vocal cord immobility, and laryngotracheal stenosis, as well as tracheomalacia, tracheoinnominate, and tracheoesophageal fistulas. We discuss the proposed mechanisms of tissue damage that relate to each and present their most common clinical manifestations, along with their respective diagnostic and management options. This article also includes a review of complications of airway management pertaining to video laryngoscopy and supraglottic airway devices. Finally, potential strategies to prevent intubation-associated injuries are outlined.

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Section: Larynxmentioning

confidence: 99%

Section: Larynxmentioning

confidence: 99%

Complications of Airway ManagementDiscussion

Pacheco-Lopez¹,

Berkow

Hillel³

et al. 2014

Respir Care

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“…The other arteries involved are the common carotid, inferior or superior thyroid arteries, or, in rare cases, the left subclavian artery. [3] In the pathophysiology, predisposing factors mostly include the use of high-pressure (above 20 mmHg), low-volume cuffed cannula that can induce mucosal erosions, excessive motion of the tracheostomy tube in patients with prolonged ventilation, placement of the tracheostomy cannula below the forth-tracheal cartilage, or anatomic anomalies such as a high-lying subclavian artery or aberrant origin of the carotid arteries. [4] In particular, there is a risk of low-placed tracheotomies or the high artery.…”

Section: Discussionmentioning

confidence: 99%

Tracheoinnominate artery fistula in a pediatric patient with idiopathic scoliosis

Onan¹

2012

Turk Gogus Kalp Dama

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“…It has also been described after surgical tracheostomy [17], but it is possible that the semi-blind technique of percutaneous tracheostomy makes inadvertent low entry into the trachea more likely. The risk of erosion into a large vessel, as occurred in our second and third patients, is therefore increased.…”

Section: Discussionmentioning

confidence: 99%

Mortality from percutaneous dilatational tracheostomy. A report of three cases*

McCormick¹,

Manara

2005

Anaesthesia

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SummaryWe report three deaths following percutaneous dilatational tracheostomy in a series of 1187 procedures undertaken in a single intensive care unit over a 13‐year period. All deaths were due to severe haemorrhage. The first patient died during the procedure from uncontrollable haemorrhage from the innominate vein. Delayed haemorrhage in the other two patients was caused by the tracheostomy tube eroding into the aorta in one patient and into the innominate vein in the other. In both these patients, the tracheal stoma was found at postmortem to be sited unexpectedly low. Fatal haemorrhage is a rare complication of percutaneous tracheostomy (0.25% in this series), but is probably under‐reported. While bronchoscopy is now used routinely during percutaneous tracheostomy insertion in most units, we speculate that ultrasound examination of the neck is more likely to identify major vascular structures at risk. However, whilst intuitive, there is little evidence that either bronchoscopy or ultrasound scanning reduces the incidence of complications. Magnetic resonance images of normal subjects are presented to demonstrate the anatomical relations of the trachea to major vascular structures and their variability.

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Tracheo-Innominate Artery Fistula After Tracheostomy

Cited by 25 publications

References 10 publications

Complications of Airway ManagementDiscussion

Complications of Airway ManagementDiscussion

Tracheoinnominate artery fistula in a pediatric patient with idiopathic scoliosis

Mortality from percutaneous dilatational tracheostomy. A report of three cases*

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