Tracheo-innominate Artery Fistula Research Articles

Successful respiratory management of a Marshall-Smith syndrome patient with a tracheo-innominate artery fistula

BackgroundTracheo-innominate artery fistula (TIF) is a life-threatening complication of tracheostomy. We describe perioperative management for innominate artery transection in a case with TIF.Case presentationA 4-year-old Japanese female with Marshal-Smith syndrome presented for management of TIF. She underwent tracheostomy at the age of 3 months and an uncuffed tracheostomy tube was inserted. One month before admission to our hospital, intermittent tracheal bleeding, suggesting TIF, occurred. Although we considered to change to a cuffed endotracheal tube, craniofacial abnormality suggested difficult oral intubation, and there was a possibility of rebleeding. Finally, innominate artery transection was performed under total intravenous anesthesia without changing the tracheostomy tube. Surgery completed uneventfully and she received mechanical ventilation under sedation for a day, followed by weaning without complications.ConclusionsA cuffed tracheostomy tube should have been inserted before surgery for effective hemostasis against sudden bleeding from TIF even though conversion to oral intubation was difficult.

Tracheo-innominate artery fistula with continuous bleeding successfully treated through the suprasternal approach: a case report

BackgroundTracheo-innominate artery fistula (TIF) is a rare but fatal complication occurring after tracheotomy. Brachiocephalic trunk transection, one of the surgical treatments for TIF, is mostly associated with a full or partial median sternotomy. We describe a case of TIF with continuous bleeding, which was successfully treated with brachiocephalic trunk transection through a collar incision without the need for median sternotomy.Case presentationCase 1.An 18-year-old man was referred to our hospital with bleeding from a tracheal stoma, which had ceased prior to admission. TIF was suspected after examination. Innominate artery transection was performed through a collar incision. TIF was not revealed when we cut the innominate artery anterior wall open; therefore, we opted for preventive surgical intervention. The post-operative course was uneventful, and the patient was asymptomatic at the 3-year follow-up.Case 2.A 14-year-old male patient was admitted to our hospital with bleeding from a tracheal stoma, and TIF was suspected after examination. There was persistent bleeding when the cuff of the tracheotomy tube was deflated. Brachiocephalic trunk transection was performed through a collar incision using balloon occlusion. The post-operative course was uneventful, and rebleeding has not occurred 2 years later.ConclusionsBrachiocephalic trunk transection without any median sternotomy may offer the benefits of post-operative infection prevention. In patients with suspected continuous bleeding, using a balloon catheter may be a safe and effective method of treatment.

Experience of Airway Securing for Risk Cases of Tracheo-innominate Artery Fistula

Experience of Airway Securing for Risk Cases of Tracheo-innominate Artery Fistula

A novel reconstruction technique of a tracheal defect in the emergent setting using a thymus flap in a patient with tracheoinnominate artery fistula

BackgroundThere is a very high mortality associated with a tracheoinnominate artery fistula; however, when patients survive, they often require reconstruction of the eroded tracheal defect after the bleeding has been controlled.Case presentationThis is the case of an 83-year-old male with a tracheoinnominate artery fistula who was stabilized in the operating room and underwent repair of his trachea. A novel technique of using the thymus gland as a pedicled flap to repair a large tracheal defect was executed after achieving hemostasis. The patient’s defect was repaired successfully following control of the fistula.ConclusionsWe have shown that the thymus gland can be used successfully as a pedicled flap for repair of a tracheal defect in the setting of a tracheoinnominate artery fistula.

A RARE CASE OF TRACHEOINOMINATE FISTULA

SESSION TITLE: Wednesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Within 2-4 weeks after placement, a tip or cuff of a tracheostomy tube may erode into the anterior wall of the trachea, resulting in a morbid and often fatal outcome. We present a rare case of tracheoinnominate fistula (TIF) after a tracheostomy. CASE PRESENTATION: A 51-year-old woman with non-ischemic cardiomyopathy after a complicated ascending aortic aneurysm status post orthotopic heart transplant presented with gradual onset of dyspnea and facial swelling. CTA of the chest revealed an aneurysm of the innominate artery measuring 3.7 x 3.4 cm and a significant subglottic tracheal stenosis. A large multinodular goiter was noted on ultrasound. Due to her diffuse facial swelling, exophthalmos, and engorged veins, her culprit diagnosis was thought to be SVC syndrome. After a subsequent CT venography, she underwent stenting of the right innominate vein. However, her symptoms persist, and as a result of her worsening stridor, the patient was intubated. She then underwent a tracheostomy and partial thyroidectomy. Twelve days post tracheostomy, patient had a self-resolving episode of non-massive hemoptysis. Given her innominate artery aneurysm, a sentinel bleed for a tracheoinnominate fistula was suspected. Her uncuffed tracheostomy tube was quickly exchanged for a cuffed one, and the balloon was hyperinflated. After a temporary tamponade, she was emergently taken to the operating room for an innominate artery ligation and a carotid-to-carotid bypass. DISCUSSION: Development of tracheoinnominate fistula is a rare complication of tracheostomy occurring in only 1% with nearly a 90% mortality. When faced with a massive hemoptysis or even a sentinel bleed, one must have a high index of suspicion for TIF in a patient with a recent tracheotomy placement. Common risk factors include low tracheostomy, high innominate artery, cuff overinflation, infection, and immunosuppressed state. Our patient unfortunately had a perfect storm—a history of a complicated ascending aortic aneurysm involving the innominate artery, on chronic immunosuppressants, and subglottic tracheal stenosis requiring a low tracheostomy. To minimize exsanguination, suspect TIF and quickly tamponade the anterior wall of the tracheal with one’s finger or overinflating the balloon. CONCLUSIONS: Tracheoinnominate fistula, although more rare since the advent of low-pressure tracheostomy tubes, remains a highly lethal complication of tracheostomy. Successful management relies on early diagnosis and prompt management. Reference #1: 1. Allan JS, Wright CD: Tracheoinnominate fistula: Diagnosis and management. Chest Surg Clin North Am 13:331-341, 2003 GrilloCG: Tacheal fistulato barchiocephalic artery,inGrilloCG (ed): Surgery of the Trachea and Bronchi. Hamilton, Ontario, BC Decker, Ch. 13, 2003, pp 1-9 Reference #2: 2. GrilloCG: Tacheal fistulato barchiocephalic artery,inGrilloCG (ed): Surgery of the Trachea and Bronchi. Hamilton, Ontario, BC Decker, Ch. 13, 2003, pp 1-9 Reference #3: 3. Technique for Managing Tracheo-Innominate Artery Fistula, Gorav Ailawadi, MD DISCLOSURES: No relevant relationships by Bindu Akkanti, source=Web Response No relevant relationships by Kha Dinh, source=Web Response No relevant relationships by Samim Jafri, source=Web Response

Tracheoinnominate Artery Fistula Post Tracheostomy: A case report and literature review

Tracheostomy is a common procedure in otorhinolaryngology and it is not without its own complications. Tracheoinnominate artery fistula is one of the late complication of tracheostomy. It commonly results in fatality if not detected and treated early. Herein, we present a rare case of a patient with underlying nasopharyngeal carcinoma post radiotherapy, cryotherapy and salvage neck dissection with tracheoinnominate artery fistula as a consequence of tracheostomy who defied statistics and was successfully stented. Objective of this case report is to create awareness regarding the differential diagnosis of massive bleeding from tracheostomy and immediate life saving measures the can be undertakenin addition to theneed to be vigilant in a patient with multiple risk factors that predisposes to the occurrence of tracheoinnominate artery fistula.International Journal of Human and Health Sciences Vol. 03 No. 04 October’19 Page : 238-240

Endovascular Treatment of Tracheoinnominate Artery Fistula: Case Report and Literature Review With Pooled Cohort Analysis

To pool data from published cases of tracheoinnominate artery fistula (TIF) treated with surgical or endovascular techniques along with reporting a case of similar presentation. A total of 261 cases in 137 published case reports and case series were identified through a comprehensive systematic literature review. Data regarding patient characteristics, treatment, and follow-up were extracted. A local case of a 14-year-old boy with TIF due to longstanding tracheostomy treated with stent-graft placement was added to the data. Comparison of the complication rates between surgical vs endovascular interventions was done with the chi-square test. Factors associated with longer survival were assessed by the Cox regression analysis. Thirty-three (12.6%) of the reported cases were treated endovascularly, 137 (52.3%) were treated surgically, and 92 (35.1%) were reported with no definitive treatment. Mean age was 34 ± 22 years, and 61% were males. The mean time interval between tracheotomy placement and bleeding was 1 ± 2.5 years. A lower procedure-related complication (30% vs 50%, P = 0.045) and 30-day mortality (9% vs 23%, P = 0.008) rates had been reported with percutaneous approaches compared to surgery. No percutaneous procedure was reported prior to year 2000. In multivariate analysis stratified by publication year, a shorter tracheostomy-to-bleeding time (year) was significantly associated with higher hazards of death (hazard ratio: 1.22, P = 0.017). Type of intervention (percutaneous vs surgery) was not associated with postintervention survival (adjusted hazard ratio: 0.78, P = 0.558). Endovascular stent grafting can have a comparable postprocedural survival and lower complication rates vs open surgical repair in treatment of TIF.

Successful Surgical Treatment of Tracheo-Innominate Artery Fistula Complicated with Tracheostomy

Successful Surgical Treatment of Tracheo-Innominate Artery Fistula Complicated with Tracheostomy

A case report of tracheo-innominate artery fistula after laryngotracheal separation

A case report of tracheo-innominate artery fistula after laryngotracheal separation

Tracheo-innominate artery fistula caused by isolated innominate artery pseudo-aneurysm rupture

Tracheo-innominate fistula (TIF) is a very rare but fatal complication of tracheostomy, with an incidence of 0.1–1.0% (1). Isolated innominate artery aneurysm is also rare but its treatment is essential due to the risk of aneurysmal rupture and a subsequent thromboembolic event. Isolated innominate artery aneurysm may cause the extrinsic compression and erosion of the trachea and, very rarely, the development of TIF (2). Here we present a case of TIF caused by the rupture of an innominate artery aneurysm.

Endovascular Stent Graft Exclusion of an Iatrogenic Tracheoinnominate Fistula after Unsuccessful Surgical Repair

AbstractA 10-year-old girl with metachromatic leukodystrophy developed a tracheoinnominate artery fistula and massive hemoptysis following tracheostomy, initially requiring open surgical repair. Massive hemoptysis recurred at 1 month due to suspected pericardial patch dehiscence. The authors herein describe the subsequent emergent treatment by stent graft exclusion and review the existing literature surrounding this rare and potentially fatal condition.

Management Strategy for Prevention of Tracheoinnominate Artery Fistula After Laryngotracheal Separation With Contrast-Enhanced Neck Computed Tomography

Management Strategy for Prevention of Tracheoinnominate Artery Fistula After Laryngotracheal Separation With Contrast-Enhanced Neck Computed Tomography

Risk Factors for Tracheo-innominate Artery Fistula after Laryngotracheal Separation/Laryngectomy in Patients with Severe Motor and Intellectual Disabilities

目的: 喉頭気管分離術・喉頭摘出術後の重篤な合併症である気管腕頭動脈瘻について, そのリスク因子を検討することを目的とした. 方法: 対象は横浜市立大学附属市民総合医療センター耳鼻咽喉科において喉頭気管分離術・喉頭摘出術を施行された重症心身障害児 (者) 21症例である. 術後気管カニューレ留置を必要とし, 気管内出血の合併症が生じた群 (n=2) を A 群, 術後気管カニューレ留置を必要とし, 気管内出血の合併症が生じなかった群 (n=6) を B 群, 術後気管カニューレ留置を必要とせず, 気管内出血の合併症が生じなかった群 (n=13) を C 群とし, この3群間で術前画像検査での気管前後径, 胸郭前後径, コブ角を検討した. 結果: 気管前後径は A 群 6.6mm, B 群 14mm, C 群 13mm (群間で有意差なし), 胸郭前後径は A 群 21mm, B 群 35mm, C 群 40mm (A 群-C 群間 p=0.03), コブ角は A 群81°, B 群24°, C 群29° (A 群-B 群間 p=0.04, A 群-C 群間 p=0.05) であった. A 群は B, C 群に比べ, 気管前後径, 胸郭前後径が短い傾向を示し, コブ角は有意に大きかった. 考察: 気管前後径, 胸郭前後径, コブ角は気管腕頭動脈瘻のリスク因子と考えられ, 術前画像評価の有用性が示唆された. 過去の文献報告を併せて考察すると, 胸郭前後径20mm以下, コブ角80～90° 以上の症例は気管腕頭動脈瘻のリスクが高いと考えられる.

Successful Bronchoscopic Management of a Tracheo-innominate Artery Fistula

Successful Bronchoscopic Management of a Tracheo-innominate Artery Fistula

A Case of Successful Treatment of Tracheo-innominate Artery Fistula

Tracheo-innominate artery fistula is known to be a serious and potentially fatal complication after tracheostomy.

Successful Treatment of a Tracheo-innominate Artery Fistula Resulting from Tracheostomy

Successful Treatment of a Tracheo-innominate Artery Fistula Resulting from Tracheostomy

A case report of tracheoinnominate artery fistula treated successfully by endovascular embolization–with partly coil defluxion after treatment

A case report of tracheoinnominate artery fistula treated successfully by endovascular embolization–with partly coil defluxion after treatment

長期気管カニューレ装着患者に発生した気管腕頭動脈瘻の 1 例

長期気管カニューレ装着患者に発生した気管腕頭動脈瘻の 1 例

Endovascular stenting of tracheoinnominate fistula after tracheostomy in a 14-year-old boy.

Tracheoinnominate artery fistula is a rare, fatal complication of tracheostomy, and prompt diagnosis and management are imperative. We report the case of tracheoinnominate artery fistula after tracheostomy in a 14-year-old boy with a history of severe periventricular leukomalacia, hydrocephalus, cerebral palsy, and epilepsy. The tracheoinnominate artery fistula was successfully treated with a stent graft insertion via the right common femoral artery. Endovascular repair of the tracheoinnominate artery fistula via stent grafting is a safe, effective, and minimally invasive treatment for patients in poor clinical conditions and is an alternative to traditional open surgical treatment.

Combined tracheoinnominate artery fistula and tracheoesophageal fistula: A very rare complication of indwelling tracheostomy tube.

Tracheoinnominate artery fistula (TIF) is a serious complication of tracheostomy. If untreated, it could be life-threatening. The emergency approach to the condition that includes prompt diagnosis, rapid control of bleeding with a clear airway, and operation with or without interruption of the innominate artery are the most important factors influencing patient outcome. Tracheoesophageal fistula (TEF) is another complication of tracheostomy. In association with compromised quality of life, this condition is really hard to be treated. We report a case of combined TIF and TEF in a 27-year-old man with quadriplegia who suffered a car accident but was successfully managed with interruption and ligature of the innominate artery repair of trachea.