Postoperative bleeding in tracheal surgery

Abstract

Tracheal surgery became relatively safe with development of thoracic surgery, endoscopy and anesthesia. However, life-threatening vascular complications especially arrosive bleeding from great vessels play important role in the structure of postoperative complications. It is a major cause of hospital mortality after tracheal surgery. Since 1963 to 2013 867 patients with cicatrical tracheal stenosis were treated. Their age ranged from 8 to 77 years. Bleeding was the main cause of death after tracheal surgery. It occurs in 31 patients among whom 22 died. 9 patients are alive. There was bleeding from small cervical vessels and carotid artery in 5 and 2 patients respectively. All patients with bleeding from brachiocephalic trunk died except 2 patients who underwent complex vascular reconstructions and recurrent complications were prevented. Vascular complications occurred after both circular tracheal resection with the anastomosis (19 patients) and tracheoplasty followed by airway lumen formation on T-shaped tube (in 11 cases) or endoscopic treatment (in 1 patient). Postoperative complications were predominantly arrosive and accompanied by wound infection or severe purulent tracheobronchitis. Blood loss was relatively small in all patients and asystole was caused by blood asphyxia in died patients. Therefore, firstly respiratory tract lumen should be isolated from source of bleeding. 22 patients were urgently operated. Intraoperative death was observed in 6 cases, 7 patients died within 2-31 days. In 7 other patients cervical soft tissues, thyroid artery collaterals and carotid artery were origin of bleeding. Final bleeding stop was performed with good immediate and long-term results in all cases. Final bleeding stop usually requires complex vascular reconstructions and it is difficult to predict their outcomes. It is necessary to prevent intraoperative bleeding because of unsatisfactory results of vascular complications management. So careful manipulations with vessels and their isolation from the tracheal anastomosis and tracheostomy channel with patient's own tissues are obligatory.