Tracheoinnominate fistula: surgical management of an iatrogenic disaster

Ridley, Ryan W.; Zwischenberger, J.B.

doi:10.1017/s0022215106001514

Cited by 42 publications

(29 citation statements)

References 10 publications

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“…[1][2][3][4]6) This recommendation is well supported by the reports, which suggest that the rate of lethal rebleeding for TIF was higher in the group with vascular reconstruction than in the group with interruption of blood flow by resection of the fistulous arterial segment. 7) The concern for the possibility of rebleeding due to failure of the suture or vascular graft has made the technique of sacrificing the blood flow well employed by surgeons.…”

Section: )mentioning

confidence: 55%

Tracheo-Innominate Artery Fistula: Two Case Reports and a Clinical Review

Komatsu

Sowa

Fujinaga

et al. 2013

Ann Thorac Cardiovasc Surg

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Tracheo-innominate artery fistula (TIF) is a surgical emergency with high mortality rates. Reported incidence is 0.1%-1.0% after tracheostomy with peak incidence 3 days to 6 weeks post procedure. TIF is usually fatal once it bleeds. For the successful management of TIF, treatment should be initiated immediately with the special considerations kept in mind. We describe two cases of TIF, and its clinical characteristics are reviewed in accordance with relevant literature.Keywords: tracheo-innominate artery fistula (TIF), tracheostomy, high-lying innominate artery source of bleeding, we performed flexible bronchoscopy that showed no active bleeding distal to the cannula tip. However, bleeding occurred again inside the tracheal tube. With the cuff of the tube maintained in the maximum hyperinflated state and the tracheostomy wound digitally compressed, the patient was immediately transferred to the operating room for surgical hemostasis. Unfortunately, we had no time to perform a computed tomography (CT) scan for this patient because this was an emergency case. A review of the CT scan, which had been taken about a year before, suggested that the TIF was probably above the sternal notch (Fig. 1). Therefore, unlike in the standard procedure, herein we made a suprasternal incision. After identifying the trachea and the overriding innominate artery, we successfully encircled the artery proximally and distally to the trachea and found the fistula posterior to the high-lying innominate artery. We debrided the fistulous segment of the innominate artery and reconstructed the artery in end-to-end fashion. Finally, the fistula of the trachea was repaired by suturing and the sternocleidomastoid flap was positioned between the trachea and artery to provide a mechanical barrier (Fig. 2). After controlling the blood flow of the fistulous segment of the artery, intra-tracheal bleeding was not observed. The amount of intra-operative bleeding was about 300 mL, and the operative time was 93 min. The post-operative course was uneventful with no sign of rebleeding. However, according to the findings of the CT

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Section: )mentioning

confidence: 55%

Tracheo-Innominate Artery Fistula: Two Case Reports and a Clinical Review

Komatsu

Sowa

Fujinaga

et al. 2013

Ann Thorac Cardiovasc Surg

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“…In the patient in our case, the artery was so friable that it could not be repaired. In order to preserve brain blood perfusion, aorto-right carotid, axillo-axillo a The bleeding point was located at the distal stump of the brachiocephalic artery (red arrow); b the artery stump was closed and reinforced with felt [12], and femoro-axillo [13] bypasses are reportedly effective following diversion of the brachial artery. As ischemic damage of the brain can develop in 10% of cases [14], arterial communication in the circle of Willis should be confirmed when bypass is not performed.…”

Section: Discussionmentioning

confidence: 99%

A successful rescue with extra-anatomical bypass for massive bleeding of the brachiocephalic artery following salvage pharyngo-esophagectomy

et al. 2012

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Massive bleeding from large vessels is a serious and life-threatening complication after radical esophagectomy. Here, we present the rare case of patient survival following two episodes of massive bleeding from a tracheobrachiocephalic artery fistula after salvage surgery for cervical esophageal cancer following definitive chemoradiation. During the first episode of bleeding, the damaged part of the brachiocephalic artery was transected with an extraanatomical arterial bypass (right femoro-axillo artery bypass graft) to maintain the arterial blood flow to the brain and the free jejunal graft. During the second bleeding, the distal stump of the brachiocephalic artery was reclosed. During both episodes of bleeding, the musculocutaneous flap was effectively employed to seal the stumps of the brachiocephalic artery and fill the dead space. Finally, the patient was discharged 351 days after the first surgery. (132/150).

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“…Tracheo-innominate artery erosion can present as hemoptysis that has temporary spontaneous resolution in about 35% of the patients [2,5]. These lesser episodes are also called ''sentinel'' or ''herald'' events because they may precede more significant bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…Endovascular treatments with stent grafts to repair the arterial wall or direct embolization have been reported more recently as either definitive [6,8] or temporizing measures [9]. Although these less invasive approaches are well established for the treatment of other vascular injuries, there are concerns about the placement of a foreign body in a contaminated great vessel [5], as well as the longterm results, especially in children who might remain tracheostomy-dependent for a long period of time.…”

Section: Discussionmentioning

confidence: 99%