Iatrogenic aortic arch injury after unsuccessful percutaneous tracheostomy

Abstract

Tracheostomy is a procedure that creates a direct opening to the airway through an incision in the anterior wall of the trachea. These days it is usually performed percutaneously as it is generally regarded as a safe procedure. We present the case of an unusual complication of aortic arch injury after percutaneous tracheostomy (PT) performed at an outside hospital. Major vascular injury was managed with sternotomy and direct aortic repair with a successful outcome. We believe PT should be performed under direct bronchoscopy visualization to limit any possible complications. Intensivists should be aware of this extremely rare complication of PT, which requires emergency cardiac surgery intervention and a team effort for appropriate management.

Percutaneous ultrasound-guided versus bronchoscopy-guided dilatational tracheostomy after median sternotomy: A case-control study

“…Moreover, aortic arch injury has been reported as an infrequent complication. [ 13 ] In this context, anticoagulation and continuation of heparinization are both debated in cardiac surgery patients, particularly in patients who require extracorporeal life support. Bektas et al[ 14 ] reported that PDT could be applied safely in patients with extracorporeal membrane oxygenation and/or left ventricular assist device, and no significant complications were encountered in the bedside PDT procedure in the patients with a mean INR value of 2 to 3.…”