Successful Treatment of a Tracheo-innominate Artery Fistula Resulting from Tracheostomy

Abstract

Tracheo-innominate artery fistula (TIF) is a rare but fatal complication of tracheostomy. We describe a patient with secondary TIF. A 76-year-old woman had undergone a tracheostomy three years previously for disordered consciousness after traumatic brain injury and subarachnoid hemorrhage. She was transferred to our hospital due to massive bleeding from the tracheostomy during exchange of the tracheostomy tube. The hemorrhage was controlled by inflating the cuff. Contrast-enhanced computed tomography confirmed TIF, for which emergency resection of the damaged innominate artery was performed via a median sternotomy. Confirming a sufficient level of stump blood pressure of the right carotid artery (64 mmHg), reconstruction of the innominate artery was abandoned. The postoperative course was not complicated except the wound infection that required surgical drainage on the tenth postoperative day. The worsening of consciousness level was not detected throughout the acute phase. Control of hemorrhage, prevention of infection, and cerebral ischemia are critical issues related to TIF. In addition to the simplicity and rapidity, resection of the innominate artery has an advantage in management of infectious complications. This procedure is a feasible option for the management of TIF, although maintaining the carotid artery stump pressure is necessary to prevent cerebral ischemia.