Tracheoinnominate Fistula After Percutaneous Tracheostomy: Successful Management with Endovascular Stenting

Castater, Christine; Hazen, Benjamin; Hoppe, Samuel; Benarroch‐Gampel, Jaime; Nguyen, Jonathan; Sondheimer, Ilan; Okpukpara, Chinedu; Busby, Stephanie

doi:10.1177/0003134820923330

Cited by 5 publications

(5 citation statements)

References 5 publications

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“…Overall, from 1965 to 2021, a total of 178 articles were found and screened with 64 studies yielding 121 patients from 18 case series and 46 case reports (Figure 1). 19-82…”

Section: Resultsmentioning

confidence: 99%

“…2,3,7,[9][10][11][12][13] Specific risk factors for TIF include a low tracheal incision during the tracheostomy, excessive initial tracheostomy cuff inflation, excessive cannula depth within the trachea, a high riding innominate artery, congenital anomalies, structural malformations, and tracheostomy site infection. [2][3][4]7,14 The pathophysiologic mechanism behind TIF formation is pressure-induced mucosal ischemia leading to erosion into the posterior wall of the innominate artery. 3,13 Definitive treatment is surgical repair, and current survival rates of TIF range from 7.3% to 50%, depending on the management approach utilized.…”

Section: Introductionmentioning

confidence: 99%

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A Systematic Review of Mortality Associations in Patients who Develop Tracheoinnominate Artery Fistula Following Tracheostomy

Ward,

Hinchman-Dominguez,

Stokes

et al. 2024

The American Surgeon™

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Objective Tracheoinnominate artery fistulas (TIFs) are a rare but deadly complication of tracheostomy. Tracheoinnominate artery fistula cases in the literature were summarized in order to understand mortality associations. Methods MEDLINE was searched for studies reporting individual characteristics of patients with TIFs after tracheostomy, excluding cases without tracheostomy or with additional procedures at the tracheostomy site. This study followed PRISMA guidelines. Results 121 TIF patients from 18 case series and 46 case reports were included. The median age was 40 years, and 52.9% were male. The overall mortality rate was 64.5%. There were differences in mortality between cases that presented initially with vs without sentinel bleeding (odds ratio [OR] .34; CI [confidence interval] .16-.73; P = .006). The mortality rate also differed in whether or not the tracheostomy cuff was over-inflated for temporary hemostasis during resuscitation (OR 3.57 (CI 1.57-8.09); P = .002). Treatment compared to no treatment had lower mortality rates (OR .11 (CI 0.04-.32); P < .001); no differences were found if treatment was endovascular vs open surgical. Conclusions Mortality is a major concern after detection of a TIF and resuscitation paired with endovascular or open surgical intervention is imperative. Rapidly investigating sentinel bleeds and intervening upon hemorrhage with temporary cuff over inflation may lead to improved outcomes.

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“…Overall, from 1965 to 2021, a total of 178 articles were found and screened with 64 studies yielding 121 patients from 18 case series and 46 case reports (Figure 1). 19-82…”

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Systematic Review of Mortality Associations in Patients who Develop Tracheoinnominate Artery Fistula Following Tracheostomy

Ward,

Hinchman-Dominguez,

Stokes

et al. 2024

The American Surgeon™

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“…[3] Tracheo-innominate artery fistula (TIF) is a life-threatening complication of prolonged tracheostomy; this is especially true in patients with tracheomalacia. Although several cases of TIF after tracheostomy have been reported, [4–6] to our knowledge, intraoperative innominate artery injury in a patient with tracheomalacia is rare.…”

Section: Introductionmentioning

confidence: 99%

Successful management of a tracheomalacia patient with active endotracheal bleeding due to intraoperative innominate artery injury: A case report

Park

Kim²,

Jung³

2022

Medicine

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Rationale: Intraoperative innominate artery injury is life-threatening in tracheomalacia patients with prolonged tracheostomy. Anesthetic management is challenging in cases with massive hemorrhage into the endotracheal tube. We report a case in which we successfully managed a tracheomalacia patient with acute endotracheal bleeding due to innominate artery injury. Patient concerns: A 24-year-old patient with tracheomalacia was scheduled to undergo exploratory thoracotomy for the treatment of intermittent bleeding at the tracheostomy site. During exploration, sudden active bleeding due to innominate artery injury was observed in the endotracheal lumen. Diagnoses: The patient was diagnosed with tracheomalacia. Interventions: We immediately used the bronchoscope to place the tip of the endotracheal tube at the bleeding site and hyperinflated the cuff. Outcomes: The ballooned cuff compressed the active bleeding site, so no additional bleeding was detected by bronchoscopy, and no additional massive bleeding was observed in the operative field. Lessons: Immediate and appropriate overinflation of the endotracheal tube cuff by an anesthesiologist may provide improved surgical field visibility and time for critical surgical procedures in cases of massive hemorrhaging.

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“…This complication occurs in 0.7% of tracheostomy patients and carries a 50-70% mortality. 1,2 We modified a low-fidelity tracheostomy manikin to instruct learners in the stepwise management of hemorrhage from a TIAF.…”

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confidence: 99%

Modified Manikin for Tracheoinnominate Artery Fistula Simulation

Tarver¹,

Jefferson²,

Parker³

et al. 2021

JETEM

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Audience: This simulator is designed to instruct emergency medicine residents in tracheostomy training that involves bleeding from the tracheostomy site. Any resident, fellow, or attending physician who cares for patients with complications from their tracheostomy might benefit from this innovation. Introduction:The emergency medicine provider must maintain proficiency in caring for patientswith complications from their tracheostomy. In the United States, over 110,000 patients receive tracheostomies per year. 1 A rare but catastrophic complication of tracheostomies, usually within the first month of placement, is a tracheoinnominate artery fistula (TIAF). This complication occurs in 0.7% of tracheostomy patients and carries a 50-70% mortality. 1,2 We modified a low-fidelity tracheostomy manikin to instruct learners in the stepwise management of hemorrhage from a TIAF. INNOVATIONS 2 Section breakEducational Methods: This modified manikin is a useful training tool for any healthcare provider who is involved in the treatment and stabilization of a variety of tracheostomy emergencies, from bleeding to infection to obstruction or dislodgement. Our case was presented on two separate occasions, to otolaryngology interns (PGY-1), and emergency medicine residents (PGY 1-3). It involved the care of a patient with a sentinel bleed and subsequent hemorrhage from a tracheoinnominate artery fistula (TIAF). This lowfidelity tracheostomy manikin provides the ideal platform for any complex, tracheostomy case, particularly where ongoing bleeding from the tracheostomy site might permanently damage the electrical circuitry of a high-fidelity model. We initially fashioned this modified manikin for tracheostomy training during a simulation "boot camp" for otolaryngology PGY-1 residents. Our use of this modified manikin for tracheostomy training was a useful teaching tool during our otolaryngology intern "boot camp." As a result, we organized a subsequent simulation training session with our PGY 1-3 emergency medicine residents to provide similar instruction in management of a TIAF. Research Methods:We provided a pre-and a post-simulation survey for the 33 emergency medicine residents who participated in the TIAF simulation with our modified tracheostomy manikin. There were 11 residents from each of the PGY-1, PGY-2, and PGY-3 year-groups. Thirty-two residents (97%) completed the pre-simulation survey, and 33 residents (100%) completed the post-simulation survey. We used a 6-point Likert Scale from "strongly agree" to "strongly disagree" to assess a resident's knowledge of multiple learning objectives within this simulation. Results:The pre-and post-simulation survey supported this simulation and manikin innovation as a useful teaching tool for tracheostomy emergencies such as a TIAF.Discussion: This was a useful innovation for emergency provider training in the recognition and management of a TIAF, a rare but emergent tracheostomy complication. In addition to this bleeding complication, this innovation might be useful for a variety of...

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Tracheoinnominate Fistula After Percutaneous Tracheostomy: Successful Management with Endovascular Stenting

Cited by 5 publications

References 5 publications

A Systematic Review of Mortality Associations in Patients who Develop Tracheoinnominate Artery Fistula Following Tracheostomy

A Systematic Review of Mortality Associations in Patients who Develop Tracheoinnominate Artery Fistula Following Tracheostomy

Successful management of a tracheomalacia patient with active endotracheal bleeding due to intraoperative innominate artery injury: A case report

Modified Manikin for Tracheoinnominate Artery Fistula Simulation

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