Abstract
Tracheoinnominate artery fistula is known as a potentially fatal complication for patients who depend on tracheostomy or tracheoesophageal diversion. Since the bleeding from a TIF is often difficult to control, preventative procedures are recommended to avoid this complication. An 11-year-old girl with hypoxic-ischemic encephalopathy and scoliosis developed tracheal stenosis caused by compression from the innominate artery. Respiratory control with intubation through the tracheal stenosis was needed, and the patient was at high risk for developing a TIF. She underwent ligation of the innominate artery at tracheostomy. Subsequent tracheostomy revealed a widened tracheal lumen and no further complications. Prophylactic ligation of the innominate artery and creation of tracheostomy might be considered as a valid option for patients at high risk of developing TIF.
Highlights
Impaired children often require tracheostomy or tracheoesophageal diversion for long-term mechanical ventilation
We report a case of ligation of the innominate artery before tracheostomy in a patient who had developed tracheal stenosis
Brain magnetic resonance computed tomography (CT) showed a normal circle of Willis with no occlusion of the internal carotid or innominate arteries. 3D CT demonstrated that the innominate artery crossed the trachea from left to right just cranial to the manubrium (Figure 4)
Summary
Impaired children often require tracheostomy or tracheoesophageal diversion for long-term mechanical ventilation. Under these circumstances, numerous complications such as tracheal wall damage, tracheal granulation, and tracheoinnominate fistula (TIF) have been reported [1,2,3]. TIF is a serious and often fatal complication. Since the survival rate is reported to be less than 30% even with surgical intervention [4, 5], preventive measures are recommended to avoid TIF. We report a case of ligation of the innominate artery before tracheostomy in a patient who had developed tracheal stenosis
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