Abstract
Purpose: Tracheoinnominate artery fistula (TIF) is a rare but fatal complication of laryngotracheal separation (LTS). To prevent this complication, we verify the positional relationship between the innominate artery and the cannula by contrast-enhanced neck computed tomography (CT) after surgery. On the basis of CT findings, we keep the cannula tip away from the artery. The aim of this study was to evaluate the efficacy of our management strategy.
Methods: We reviewed the medical records of 39 patients managed with our strategy after LTS in our institution between April 2006 and December 2015. We categorized the patients into 3 groups on the basis of the CT findings: the cannula tip (A) does not reach the artery, (B) is adjacent to the artery, or (C) rides across the artery. We examined the number of TIF cases, the cause of TIF, and the counterplan for the patients in group B.
Results: Of the 39 patients enrolled, 13 were categorized into group A, 12 into group B, and 14 into group C, on the basis of the initial CT findings after the operation. As the counterplan for group B, we substituted a shorter cannula in 6 patients, adjusted the position of cotton gauze in 5, and removed the cannula in 1. Only one (2.6%) patient (in group A) developed TIF within a mean of 4.5 years of observation, in whom a longer cannula was substituted at another hospital.
Conclusions: Our management strategy is effective for the prevention of TIF.
