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

Kaneko, Shotaro; Uchida, Keiji; Karube, Norihisa; Kasama, Keiichiro; Minami, Tomoyuki; Cho, Tomoki; Izubuchi, Ryo; Fushimi, Kenichi; Yabu, Naoto; Goda, Motohiko; Masuda, Munetaka

doi:10.1186/s13019-020-1080-y

Cited by 5 publications

(5 citation statements)

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“…TIF is known as fatal complication after tracheostomy and laryngotracheal separation. To prevent TIF formation after tracheostomy or laryngotracheal separation, several surgical techniques, including innominate artery transection [ 10 , 11 ], innominate artery transection with additional revascularization [ 1 , 12 ], and sternotomy [ 1 , 2 , 12 ] have been reported. However, due to decreased cerebral blood flow or anomalies of the arteries of the circle of Willis, which can occur in up to 54.8% of cases, innominate artery dissection is often contraindicated.…”

Section: Discussionmentioning

confidence: 99%

Anterior mediastinal tracheostomy for severe tracheal stenosis in a child with severe motor and intellectual disabilities: a case report

et al. 2023

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Background Owing to recurrent aspiration pneumonia and airway stenosis secondary to thoracic deformities, tracheostomy or laryngotracheal separation are often necessary in children with severe motor and intellectual disabilities. However, these procedures are associated with the risks of tracheal stenosis due to tracheal granulation and tracheoinnominate artery fistula formation. We report a case of a child with severe motor and intellectual disabilities treated with an anterior mediastinal tracheostomy. Case presentation The patient was a 15-year-old boy with severe motor and intellectual disabilities due to intractable epilepsy. Due to thoracic deformity and tracheomalacia, the patient had a flattened and narrowed trachea. Accordingly, laryngotracheal separation was performed 4 months before admission to avoid aspiration pneumonia. Due to a common cold, the patient required frequent sputum suctioning, which exacerbated the tracheal stenosis. Bronchoscopy revealed tracheal stenosis 4–5 cm caudal to the tracheostomy site, tracheal mucosal ulcers, and pulsation of the innominate artery on the anterior wall of the trachea. We performed an anterior mediastinum tracheostomy to release the tracheal stenosis and prevent tracheoinnominate artery fistula formation. Conclusions Anterior mediastinal tracheostomy has several advantages. Including sufficient release of bony compression, release of tracheal hyperextension, and relief of tracheal and innominate artery contact ensures a cannula-free tracheostomy, and there is no need to dissect the brachiocephalic artery. It is the procedure of choice in cases of head and neck malignancies requiring extensive tracheal resection and could be a good surgical option for severe tracheal stenosis and tracheoinnominate artery fistula in children with severe motor and intellectual disabilities.

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Section: Discussionmentioning

confidence: 99%

Anterior mediastinal tracheostomy for severe tracheal stenosis in a child with severe motor and intellectual disabilities: a case report

et al. 2023

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“…The most common complications of tracheostomy are obstruction of the cannula by a mucous plug, bleeding from the cervical wound, subcutaneous emphysema and pneumothorax or even pneumomediastinum. Innominate artery fistula in the lumen remains an exceptional complication since it is only described in 0.1% to 1% of cases [1] [2] [3]. Since Korte first reported a rupture of the innominate artery after tracheostomy in a 5-year-old with diphtheria in 1879, trachea-innominate fistula has been recognized to be a potentially fatal complication of tracheostomy [8].…”

Section: Discussionmentioning

confidence: 99%

“…Depending on the authors, this duration varies from a few days to several years. Shotaro Kaneko et al in 2020 described arterio-tracheal fistulas occurring after 4 and 12 years in two adolescents [1] while Juno Deguchi et al…”

Section: Discussionmentioning

confidence: 99%

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A Fatal Arterio-Tracheal Fistula Post-Tracheostomy: A Case Report in a Sub-Saharan Setting

Mossus¹,

Nkomo²,

Ngouatna³

et al. 2022

IJOHNS

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Fatal bleeding in patients with tracheostomy is an uncommon incident, in the order of 0.1% to 1% of cases. It is secondary in 70% of cases to the innominate artery fistula in the tracheal lumen. The fistula is generally created after the necrosis of tracheal rings. The incriminated factors are the type of cannula used, the site of tracheal opening below the 3rd tracheal ring, tracheal infections and the proximity of the innominate artery to the tracheal axis. The outcome of this incident is fatal in most cases. We report the case of a 59-year-old patient with a tracheostomy on the 11th day of his admission to intensive care for severe head trauma secondary to a road accident. On the 22nd day of his admission, the occurrence of a cataclysmic and fatal haemorrhage through the tracheostomy tube evoked an arterio-tracheal fistula of the innominate artery.

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“…The basic surgical approach in a brachiocephalic artery transection is a total or partial median sternotomy [ 1 , 4 ]. Various alternatives, such as oblique partial manubriotomy [ 5 ], the suprasternal approach [ 3 , 6 ], and the left anterior extrapleural approach [ 7 ], were reportedly effective in minimizing invasiveness and the risk of wound contamination. However, these alternatives are limited by various types of chest deformation and anatomical displacement of the brachiocephalic artery in individual cases [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

Inverse T-shaped sternotomy as novel thoracoplasty for severe chest deformation and tracheal stenosis

et al. 2021

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Background Patients with severe motor and intellectual disabilities often suffer from tracheal stenosis due to chest deformation and brachiocephalic artery compression, which sometimes leads to serious complications, such as dying spell and tracheobrachiocephalic artery fistula. We herein described our experience of performing a novel and simple thoracoplastic procedure combined with brachiocephalic artery transection in two patients with severe chest deformation and tracheal stenosis. Case presentation The patients were a 12-year-old female with cerebral palsy due to periventricular leukomalacia and a 21-year-old male with subacute sclerosing panencephalitis stage IV in the Jabbour classification following a laryngotracheal separation. Both patients showed severe chest deformation and symptoms of airway stenosis resulting in dying spells. The sternum was laterally transected between the manubrium and the sternal body, and a manubriotomy was performed longitudinally, ending with an inverse T-shaped sternotomy. Since the clavicle and the first rib remained attached to the halves of the divided manubrium, the sternum was allowed to be left open, resulting in improvement of the mediastinal narrowing and tracheal stenosis. Postoperative computed tomography (CT) showed that the distance between the halves of the manubrium was maintained at 10–11 mm, and that the mediastinal narrowing in both patients improved; the sternocervical spine distance increased from 20 mm to 22 and 13 mm to 16 mm, respectively. The patients’ tracheal stenosis below the sternal end of the clavicle and the manubrium and respiratory symptoms improved, and the patients are currently at home in a stable condition with no chest fragility and no upper limb movement disorder 1 year after surgery. Conclusions Our observations suggested that the inverse T-shaped sternotomy combined with brachiocephalic artery transection may relieve symptoms of tracheal stenosis due to severe chest deformation in patients with severe motor and intellectual disabilities.

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

Cited by 5 publications

References 4 publications

Anterior mediastinal tracheostomy for severe tracheal stenosis in a child with severe motor and intellectual disabilities: a case report

Anterior mediastinal tracheostomy for severe tracheal stenosis in a child with severe motor and intellectual disabilities: a case report

A Fatal Arterio-Tracheal Fistula Post-Tracheostomy: A Case Report in a Sub-Saharan Setting

Inverse T-shaped sternotomy as novel thoracoplasty for severe chest deformation and tracheal stenosis

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