Abstract
ABSTRACTObjective: Tracheoinnominate fistula (TIF) is a rare and frequently lethal complication of tracheostomies. Immediate bleeding control and surgical treatment are essential to avoid death. This report describes the successful endovascular treatment of TIF in a preschooler and reviews the literature concerning epidemiology, diagnosis, prophylaxis, and treatment of TIF in pediatric patients.Case description: A tracheostomized neurologically impaired bed-ridden three-year-old girl was admitted to treat an episode of tracheitis. Tracheostomy had been performed two years before. The child used a plastic cuffed tube continually inflated at low pressure. The patient presented two self-limited bleeding episodes through the tracheostomy in a 48h interval. A new episode was suggestive of arterial bleeding, immediately leading to a provisional diagnosis of TIF, which was confirmed by angiotomography, affecting the bifurcation of the innominate artery and the right tracheal wall. The patient was immediately treated by the endovascular placement of polytetrafluoroethylene (PTFE)/nitinol stents in Y configuration. No recurrent TIF, neurological problems, or right arm ischemia have been detected in the follow-up.Comments: TIF must be suspected after any significant bleeding from the tracheostoma. Endovascular techniques may provide rapid bleeding control with low morbidity, but they are limited to a few case reports in pediatric patients, all of them addressing adolescents. Long-term follow-up is needed to detect whether stent-related vascular complications will occur with growth.
Highlights
Tracheostomy is often indicated for children with severe chronic encephalopathy
Lethal complications are related to accidental decannulation, cannula obstruction, and tracheoinnominate fistula (TIF)
We describe the case of successful endovascular treatment of TIF in a preschooler and review the literature concerning epidemiology, diagnosis, prophylaxis, and treatment of TIF in neurologically impaired pediatric patients
Summary
Tracheostomy is often indicated for children with severe chronic encephalopathy. Lethal complications are related to accidental decannulation, cannula obstruction, and tracheoinnominate fistula (TIF). Tracheostomy is frequently used as a definitive treatment These patients are prone to late tracheostomy complications: in this group, most TIF episodes are late. A three-year-old bed-ridden girl presenting a chronic neurologic condition (Zika syndrome) was admitted to treat an episode of tracheitis. She had been submitted to tracheostomy and gastrostomy two years before to treat chronic pulmonary aspiration, recurrent episodes of pneumonia, and swallowing incoordination. The patient presented two self-limited bleeding episodes through the tracheostomy in a 48h interval, initially attributed to aspiration trauma. The patient remains asymptomatic, without new bleeding episodes, as well as infectious, thrombotic, or ischemic complications related to the stents
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