A case of unsuccessful treatment of a tracheo-innominate artery fistula

Abstract

The case of an 82-year-old woman who developed cerebral infarction, was admitted to the ICU of Hokkaido University Hospital and subsequently underwent percutaneous tracheostomy is described. Two months after the tracheostomy, a massive tracheal hemorrhage occurred due to a tracheo-innominate artery fistula （TIF） . An emergency operation was performed （primary closure of the fistula, then envelopment with an anterior cervical muscle flap） . Three weeks after the surgery, enhanced CT indicated the presence of an innominate artery aneurysm. With suspected rupture, the innominate artery was resected and replaced with artificial materials and covered with a pectoral major musculo-cutaneous flap （PMMC） .However, 6 weeks after PMMC reconstruction, the patient had an episode of uncontrolled bleeding and consequently died due to severe blood loss.TIF is considered to be one of the critical complications of tracheostomy and clinicians should keep this in mind during tracheostomy to prevent its occurrence.: percutaneous tracheostomy, tracheo-innominate artery fistula, artificial materials