Prevention of Tracheo-Innominate Artery Fistula by Using an Adjustable Tracheostomy Tube

Abstract

Tracheo-innominate artery fistula (TIF) is a severe complication associated with a long-term tracheostomy, and TIF-associated bleeding has a high mortality rate. Here, we report two patients who were considered to be at high risk of developing TIF due to retrocollis after tracheostomy. The patients were an 82-year-old woman with Parkinson’s disease (PD) and a 64-year-old man with multiple system atrophy (MSA). Both patients underwent tracheostomy at an advanced stage and later showed retrocollis. Colored and 3D-reconstructed computed tomography (CT) showed tracheal deformation into a C curve, with the tip of the tracheostomy tube attached to the anterior wall, where the innominate artery transverses. Since they were considered to be at high risk of developing TIF, we used an adjustable tracheostomy tube. Follow-up CT revealed that the tip of the new tracheostomy tube had separated from the tracheal anterior wall. Although retrocollis is rare in PD and MSA, it can develop at the end stage of these diseases. An adjustable tracheostomy tube may be an option for preventing TIF development in cases where surgical intervention would be difficult.

A Systematic Review of Mortality Associations in Patients who Develop Tracheoinnominate Artery Fistula Following Tracheostomy

“…Tracheostomies are commonly performed surgical procedures, with TIF being a rare but serious complication that can arise due to idiosyncratic patient characteristics, surgical indication, and the procedural variables of the surgical technique. [1][2][3][4][5]7,[9][10][11][12][13] Due to the low clinical incidence of this condition and its high mortality rate, robust evidence regarding optimal treatment approaches is lacking. 2,3,7,12,15 Given the breadth of indications for tracheostomy procedures and the variety of providers performing the procedure, there was variability in setting, technique, postoperative care, and data variables reported.…”

“…1,2 Although a common procedure, there are multifarious complicating factors such as the incision location, normal variations in patient anatomy, or the presence of a neck mass. [3][4][5] Furthermore, an emergently performed tracheostomy has higher complication and mortality rates than an elective tracheostomy. 6 A tracheoinnominate artery fistula (TIF) is a specifically concerning complication, where an abnormal connection is formed between the innominate (brachiocephalic) artery and the trachea, and usually occurs more than 3 weeks postoperatively.…”