2020 Volume 41 Issue 1 Pages 27-33
Innominate artery fistula is a rare but severe complication after tracheostomy or laryngotracheal separation. As rupture of the artery causes lethal bleeding, it is important to prevent bleeding by surgical ligation of the artery. In the present study, with the aim of safe management for a tracheal cannula we retrospectively reviewed the medical records of six patients with severe motor and intellectual disabilities (SMID) in whom innominate artery ligation was performed. We also evaluated the symptoms, fiberscopic findings of the trachea, and imaging findings. In one case, tracheoinnominate artery fistula was diagnosed and an emergency operation was performed. Prophylactic surgery was done in other cases. In all the cases, some findings such as erosion, ulceration, in the anterior wall of the trachea, and tracheal stenosis due to compression by the upper shift of the innominate artery were identified during fiberscopic examination. Postural changes, such as scoliosis or retroflexion of the head were also detected in all the patients. A small amount of precede bleeding was detected in three of the six cases. The median value of the Cobb angle was 61.0° in radiographs, and the diameter of the thorax was 18.7 mm, the anteroposterior distance of the trachea was 5.0 mm in the CT scan, which was correspond to risk factors reported in previous studies. The long duration of insertion of the tracheal cannula increases the risk of innominate artery fistula. Hence, physicians should frequently assess the inner lumen of the trachea by using fiberscope, order the CT scan, and decide the indication for innominate ligation surgery.
