Late Cataclysmic Hemorrhage from the Innominate Artery after Tracheostomy

Abstract

We report on 12 patients sustaining late cataclysmic hemorrhage as a complication of tracheostomy or endotracheal intubation, resulting from erosion of the innominate artery. Four long-term survivors are reported. A number of surgical techniques was used and up-to-date management is briefly described. Our technique mainly consists of transecting and suturing the innominate artery without prior debridement. Innominate artery blood flow was not reestablished in all patients, thereby avoiding local wound infection and recurrence of hemorrhage. Initial temporary control of bleeding was achieved either by hyperinflation of the cuff of the tracheostomy tube, or finger compression of the innominate artery against the sternal notch. Definite surgical repair of this lesion and reestablishment of innominate artery flow is carried out through complete sternotomy in combination with right cervical extension which is considered the incision of choice by the authors. To prevent this unusual and lethal complication, tracheostomy should not be used without proper indication and technical errors of its performance, such as placing it lower than the level of third tracheal ring, must be avoided.

Tracheo-brachiocephalic artery fistula after tracheostomy associated with thoracic deformity: a case report

“…In 30% to 50% of cases there is some bleeding prior to onset [1]. Since the onset is sudden massive bleeding, the prognosis is poor; the reported survival rate is 10% to 30% [3]. The direct cause of bleeding is the formation of a fistula with the trachea subsequent to arterial injury by the tracheostomy tube.…”

Innominate Artery Erosion Complicating Use of Tracheal Tube with Adjustable Flange

“…Innominate artery erosion is a rare but often fatal com plication of tracheostomy occurring most commonly be tween the first and second postoperative week [1][2][3][4], Few patients survive even if the surgical repair is successful [3,5]. The high mortality rate emphasizes the importance of both the surgical repair procedure and management to prevent such a disastrous complication [5].…”

“…The high mortality rate emphasizes the importance of both the surgical repair procedure and management to prevent such a disastrous complication [5].…”

Indication for and technical refinements of submental intubation in oral and maxillofacial surgery

“…Tracheal stenosis linked to the healing of the tracheal wound (Viau et al, 1988;Wood and Mathisen, 1991;Goldenberg et al, 2002), severe haemorrhages secondary to intra-operative injury of cervical vessels or the thyroid gland (Kmiecik et al, 1976;Tschang and Cramer, 1977;Hafez et al, 1984;Goldenberg et al, 2002), tracheotomy wound infections (Viau et al, 1988) and unsightly scars have been reported. Some authors stress that the overall mortality rate directly due to the tracheotomy may lie between 0.7% and 1.7%.…”