Tracheal-innominate artery fistula after repair of tracheal stenosis: Problem and prevention

Abstract

Tracheal-innominate artery fistula was a lethal complication in 1 patient out of a series of 13 who have required tracheal resection and end-to-end anastomosis for symptomatic tracheal stenosis secondary to prolonged endotracheal cuff inflation. In 9 of these patients, the innominate artery was entrapped in the peritracheal fibrous tissue at the point where the innominate artery crossed the stenotic tracheal segment. In the first patient who developed this problem, we had placed only loose aerolar tissue between the innominate artery and the tracheal anastomosis at the time of tracheal repair. Ten days postoperatively he developed a fatal tracheal-innominate artery fistula. In the next 8 patients in whom the innominate artery was bound down to the tracheal scar, we have protected the thinned-out innominate artery from the tracheal repair site with a double-thickness pericardial flap. All these patients recovered and none developed a tracheal-innominate artery fistula.