Trachea-innominate Artery Fistula Research Articles

Therapeutic outcomes of laryngeal closure and laryngostomy in children with recurrent pneumonia

PurposeChildren with medical complexity frequently experience difficulty breathing and swallowing and occasionally develop aspiration pneumonia. Long-term intubation may cause fatal trachea-innominate artery fistula (TIF). In the present study, we retrospectively evaluated the efficacy of laryngeal closure and laryngostomy in children with medical complexity. Materials and methodsLaryngeal closure and laryngostomy were performed in eight children with severe neuromuscular disorders who were incapable of oral ingestion and verbal communication. The laryngostoma was placed at a higher position compared to that in conventional tracheostomies for easier management of the airway and to prevent TIF. ResultsAspiration was successfully prevented postoperatively in all cases. Laryngocutaneous fistula formation was not observed. Two patients successfully achieved oral ingestion capability and tracheal cannulas were removed in two patients. Among the six patients who needed a mechanical ventilator before surgery, two patients were weaned from mechanical ventilation. Five patients were successfully discharged from the hospital. Although two patients died because of their primary condition, pneumonia exacerbation was not observed in any of the patients. ConclusionCompared to the conventional tracheostomy, our procedure improved airway management and function in children with medical complexity and reduced the risk of TIF.

Tracheoinnominate fistula: acute bleeding and hypovolemic shock due to a trachea-innominate artery fistula after long-term tracheostomy, treated with a stent-graft

BackgroundA tracheo-innominate fistula is a rare but life-threatening complication of tracheostomy and has a mortality rate of 100% without therapy. The underlying cause is an acquired fistula between the brachiocephalic trunk and the trachea, induced by a tracheostomy cannula’s mechanical impact.Case presentationA 25-year-old female was admitted with pulsatile bleeding from a tracheostomy. The cause of the bleeding was a tracheo-innominate artery fistula, which was difficult to recognize. Said fistula was treated with implantation of a self-expanding stent-graft. The bleeding stopped immediately after the implantation of the stent-graft. Dual antiplatelet medication with aspirin IV and ticagrelor PO, bridged with a bolus of eptifibatide IV, was started right after the stent deployment.ConclusionsEndovascular self-expanding stent-graft implantation is a viable treatment option for tracheo-innominate artery fistulae, especially in hemorrhagic emergencies.

Operative management of catastrophic bleeding in the head and neck

The otolaryngologist commonly performs several procedures in close proximity to the carotid and innominate arterial systems. In this article, we will discuss the management of catastrophic bleeding following adult tonsillectomy and tracheostomy, as well as the management of carotid blowout syndrome in head and neck cancer patients. Although the bleeding risk from tonsillectomy is considered very low, the acceptance of transoral robotic surgery as a treatment modality of oropharyngeal head and neck carcinomas makes the spectre of catastrophic oropharyngeal bleeding more real. Aggressive resection in this area can leave minimal parapharyngeal fat over the carotid artery and damage from manipulation of smaller vessels can lead to pseudoaneurysms. Tracheostomy also carries a very low but real risk of trachea-innominate artery fistula, which has devastating consequences. Finally, we will discuss how to identify head and neck cancer patients who are at risk for carotid blowout syndrome as well as appropriate interventions to manage this condition.

A Case of Preventive Brachiocephalic Artery Transection for Avoiding Trachea-innominate Artery Fistula

A Case of Preventive Brachiocephalic Artery Transection for Avoiding Trachea-innominate Artery Fistula

A life-saving approach to trachea-innominate artery fistula: endovascular stent

A life-saving approach to trachea-innominate artery fistula: endovascular stent

Closure of the larynx for intractable aspiration in neurologically impaired patients

We present three patients with intractable aspiration pneumonia in the setting of permanent neurologic impairment, who had received a tracheostomy and showed a juxtaposition of the innominate artery against the trachea. Neurologically impaired patients often show a juxtaposition or compression of the innominate artery against the trachea by chest deformity in the setting of severe scoliosis, which could result in a trachea-innominate artery fistula. For intractable aspiration, laryngotracheal separation is safely performed and effective in controlling aspiration, but is occasionally complicated by trachea-innominate artery fistula. As an alternative procedure, we performed a closure of the larynx in these three cases, using double flaps of the vocal folds and false vocal folds, as a treatment for intractable aspiration. After operation, the patients did well without complication or clinical evidence of recurrent aspiration.

Bleeding around a tracheostomy wound: what to consider and what to do?

All patients with bleeding in and around a tracheostomy must be investigated to exclude a serious cause. The overall incidence is approximately 5 per cent of tracheostomies performed in Adult Intensive Care Units (AICU). When bleeding commences more than 72 hours post-operatively, the possibility of a trachea innominate artery fistula needs to be excluded by endoscopic examination of the trachea in an operating theatre environment, with the facility to proceed to exploration of the neck and possibly to sternotomy to enable ligation of the innominate artery. With appropriate recognition, diagnosis, resuscitation and surgical intervention, the associated high death rate of trachea innominate artery fistula can be reduced.

Preventive ligation of the innominate artery in patients with neuromuscular disorders

Tracheostomy, long-term mechanical ventilation, spinal deformaties are factors that contribute in patients with neuromuscular disorders to the development of an erosion of the tracheal wall and subsequent formation of a tracheo-innominate artery fistula. This condition is fatal unless promptly treated by exclusion of the innominate artery, which is often performed under desperate circumstances. We electively adopted a preventive ligation of the innominate artery in patients at risk for trachea-innominate artery fistula (TIF). We present seven patients with neuromuscular disorders who underwent preventive ligation of the innominate artery. All seven patients survived.

術後２度腕頭動脈穿孔をきたした喉頭癌肉腫例

Innominate artery fistulas require a surgical procedure, although the prognosis is usually very poor because of complications such as re-bleeding and infection. A 50-year-old man presented with laryngeal carcinosarcoma (T1a, N0, M0). Partial laryngectomy was performed but there was a recurrence; therefore, total laryngectomy, total thyroidectomy, right radical neck dissection, left functional neck dissection, skin-combined resection and D-P flap were performed. On postoperative day 6, after intense coughing, copious hemorrhage from the tracheostoma was demonstrated. Immediately, bleeding was arrested by pressing the tracheostoma. Fistula of the innominate artery was then repaired using left great saphenous vein, but recurrent perforation of the innominate artery developed. Therefore, innominate artery transection and omentopexy were performed. These results demonstrate that in cases of trachea-innominate artery fistula, innominate artery transection should be performed first.

Trachea-innominate artery fistula and concomitant critical cerebrovascular disease

To avoid the laborious task of investigating the cerebrovascular circulation in the midst of a trachea-innominate artery fistula, we strongly recommend preoperative cerebrovascular investigations in all patients about to undergo mediastinal tracheostomy. Paramount to this dictum remains the possibility of asymptomatic cerebrovascular disease. Inadequate preoperative cerebrovascular assessment may result in, as described in this report, the possibility of significant postoperative neurologic morbidity or mortality. Angiography should assist the surgeon in deciding which method of cerebral arterial reconstruction is best suited to the individual circumstance. We recommend the avoidance of innominate artery reconstruction even with the interposition of autologous tissues, as the operative field remains grossly infected.

Management of trachea-innominate artery fistula

The case histories of three patients with trachea-innominate artery fistula are presented. Low tracheostomy was the etiologic factor producing the fistula in two patients. In both cases, the neck was hyperextended by placing a large roll behind the patient's shoulders and thereby elevating the trachea out of the mediastinum. In one patient a balloon cuff eroded the innominate artery. Management of these patients includes control of hemorrhage by cuff overinflation and/or by endotracheal intubation and packing of the tracheostomy site. The best surgical approach is via a right anterior thoracotomy and a separate neck incision to isolate the blood vessels involved. Median sternotomy should be avoided to prevent mediastinal infection and sternal dehiscence. Carotid stump pressures are a useful guide to determine the efficacy of innominate artery ligation. One patient was saved and is a long-term survivor.

Trachea–Innominate Artery Fistula: Successful Management or 3 Consecutive Patients

Trachea-innominate artery fistula is an uncommon but frequently fatal complication of tracheostomy. Three successive patients who developed this complication while receiving ventilatory assistance through a tracheostomy tube were successfully managed, with long-term survival. Bleeding was controlled by direct digital pressure on the innominate artery or by hyperinflation of the balloon cuff of the tracheostomy tube. In 2 patients, replacement of the tracheostomy tube with an orotracheal tube improved direct access to the innominate artery for digital compression. Late follow-up examination of the right carotid circulation revealed complete reversal of flow in the right internal and common carotid arteries in the 2 patients studied.

Trachea — Innominate Artery Fistula Following Tracheostomy: Successful Repair Using an Innominate Vein Graft

This report discusses the first recorded patient in whom a trachea–innominate artery fistula after tracheostomy was treated successfully by resection of the eroded segment of artery followed by graft replacement using the patient's left innominate vein. The mechanism of vessel erosion and its prevention are discussed. Also, suitable methods are presented for obtaining temporary control of the severe hemorrhage associated with a tracheoarterial fistula while simultaneously maintaining an adequate airway.