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Ward K, Hinchman-Dominguez D, Stokes L, Norton EL, Narveson JR, Punja VP. A Systematic Review of Mortality Associations in Patients who Develop Tracheoinnominate Artery Fistula Following Tracheostomy. Am Surg 2024; 90:1648-1656. [PMID: 38217444 DOI: 10.1177/00031348241227211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
OBJECTIVE Tracheoinnominate artery fistulas (TIFs) are a rare but deadly complication of tracheostomy. Tracheoinnominate artery fistula cases in the literature were summarized in order to understand mortality associations. METHODS MEDLINE was searched for studies reporting individual characteristics of patients with TIFs after tracheostomy, excluding cases without tracheostomy or with additional procedures at the tracheostomy site. This study followed PRISMA guidelines. RESULTS 121 TIF patients from 18 case series and 46 case reports were included. The median age was 40 years, and 52.9% were male. The overall mortality rate was 64.5%. There were differences in mortality between cases that presented initially with vs without sentinel bleeding (odds ratio [OR] .34; CI [confidence interval] .16-.73; P = .006). The mortality rate also differed in whether or not the tracheostomy cuff was over-inflated for temporary hemostasis during resuscitation (OR 3.57 (CI 1.57-8.09); P = .002). Treatment compared to no treatment had lower mortality rates (OR .11 (CI 0.04-.32); P < .001); no differences were found if treatment was endovascular vs open surgical. CONCLUSIONS Mortality is a major concern after detection of a TIF and resuscitation paired with endovascular or open surgical intervention is imperative. Rapidly investigating sentinel bleeds and intervening upon hemorrhage with temporary cuff over inflation may lead to improved outcomes.
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Affiliation(s)
- Katherine Ward
- School of Medicine, Creighton University, Omaha, NE, USA
| | | | - Laura Stokes
- School of Medicine, Creighton University, Omaha, NE, USA
| | | | - Joel R Narveson
- Department of Trauma Surgery and Critical Care, Creighton University Medical Center, Omaha, NE, USA
| | - Viren P Punja
- Department of Trauma Surgery and Critical Care, Creighton University Medical Center, Omaha, NE, USA
- Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA
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Tomita H, Shimotakahara A, Shimojima N, Ishihama H, Ishikawa M, Mizuno Y, Hashimoto M, Tsukizaki A, Miyaguni K, Hirobe S. Inverse T-shaped sternotomy as novel thoracoplasty for severe chest deformation and tracheal stenosis. Surg Case Rep 2021; 7:194. [PMID: 34436697 PMCID: PMC8390590 DOI: 10.1186/s40792-021-01275-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/16/2021] [Indexed: 12/03/2022] Open
Abstract
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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Affiliation(s)
- Hirofumi Tomita
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan.
| | - Akihiro Shimotakahara
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Naoki Shimojima
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Hideo Ishihama
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Miki Ishikawa
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Yuki Mizuno
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Makoto Hashimoto
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Ayano Tsukizaki
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Kazuaki Miyaguni
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Seiichi Hirobe
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
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Jesus LED, Silva EWGMD, Balieiro M, Feldman K, Dekermacher S. Post-tracheostomy tracheoinnominate fistula: endovascular treatment. ACTA ACUST UNITED AC 2021; 40:e2020229. [PMID: 34259783 PMCID: PMC8280763 DOI: 10.1590/1984-0462/2022/40/2020229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/02/2020] [Indexed: 12/01/2022]
Abstract
Objective: Tracheoinnominate fistula (TIF) is a rare and frequently lethal complication of tracheostomies. Immediate bleeding control and surgical treatment are essential to avoid death. This report describes the successful endovascular treatment of TIF in a preschooler and reviews the literature concerning epidemiology, diagnosis, prophylaxis, and treatment of TIF in pediatric patients. Case description: A tracheostomized neurologically impaired bed-ridden three-year-old girl was admitted to treat an episode of tracheitis. Tracheostomy had been performed two years before. The child used a plastic cuffed tube continually inflated at low pressure. The patient presented two self-limited bleeding episodes through the tracheostomy in a 48h interval. A new episode was suggestive of arterial bleeding, immediately leading to a provisional diagnosis of TIF, which was confirmed by angiotomography, affecting the bifurcation of the innominate artery and the right tracheal wall. The patient was immediately treated by the endovascular placement of polytetrafluoroethylene (PTFE)/nitinol stents in Y configuration. No recurrent TIF, neurological problems, or right arm ischemia have been detected in the follow-up. Comments: TIF must be suspected after any significant bleeding from the tracheostoma. Endovascular techniques may provide rapid bleeding control with low morbidity, but they are limited to a few case reports in pediatric patients, all of them addressing adolescents. Long-term follow-up is needed to detect whether stent-related vascular complications will occur with growth.
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Affiliation(s)
- Lisieux Eyer de Jesus
- aHospital Federal dos Servidores do Estado, Ministry of Health, Rio de Janeiro, RJ, Brazil
| | | | - Marcos Balieiro
- aHospital Federal dos Servidores do Estado, Ministry of Health, Rio de Janeiro, RJ, Brazil
| | | | - Samuel Dekermacher
- aHospital Federal dos Servidores do Estado, Ministry of Health, Rio de Janeiro, RJ, Brazil
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Morimoto N, Maekawa T, Kubota M, Kitamura M, Takahashi N, Kubota M. Challenge for management without tracheostomy tube after laryngo-tracheal separation in children with neurological disorders. Laryngoscope Investig Otolaryngol 2021; 6:332-339. [PMID: 33869766 PMCID: PMC8035946 DOI: 10.1002/lio2.534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/26/2020] [Accepted: 01/20/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The present study analyzed surgical outcomes of laryngotracheal separation (LTS) in children with neurological disorders. The purpose of this study was to investigate respiratory impairment and severe complications after LTS in children, and identify the possibility of permanent tracheostomy without a tracheostomy tube as the safest respiratory management method. METHODS Twenty-eight patients (male:female = 16:12) with neurological disorders (6 months to 32 years) who underwent LTS between January 2012 and April 2018 were reviewed. Tracheal diameter, Cobb angle, and sternocervical spine distance (SCD) were measured to assess the potential risk and possibility of removing tracheostomy tube management. RESULTS Tracheostomy tube could be removed shortly after LTS in 57% (16/28). However, nine of these patients developed respiratory problems that required tracheostomy tube placement 2 years after LTS. New requirements for a tracheostomy tube as a stent were strongly correlated with SCD (P < .05, odds ratio > 1) as well as tracheal deformity. CONCLUSIONS Respiratory management in neurologically impaired children after LTS without a tracheostomy tube is challenging because thoracic deformity during physical growth affects tracheal disfiguration. Thoracic deformities and progression of scoliosis should be considered in respiratory management approaches in children with neurological disorders, and long-term follow-up by computed tomography is necessary. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Noriko Morimoto
- Department of OtolaryngologyNational Center for Child Health and DevelopmentTokyoJapan
| | - Takanobu Maekawa
- Department of General Pediatrics and Interdisciplinary medicineNational Center for Child Health and DevelopmentTokyoJapan
| | - Masaya Kubota
- Department of NeurologyNational Center for Child Health and DevelopmentTokyoJapan
| | - Masayuki Kitamura
- Department of RadiologyNational Center for Child Health and DevelopmentTokyoJapan
| | - Nozomi Takahashi
- Department of OtolaryngologyNational Center for Child Health and DevelopmentTokyoJapan
| | - Mitsuru Kubota
- Department of General Pediatrics and Interdisciplinary medicineNational Center for Child Health and DevelopmentTokyoJapan
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Taniguchi Y, Matsubayashi Y, Kato S, Oguchi F, Nohara A, Doi T, Oshima Y, Tanaka S. Tracheal stenosis due to cervicothoracic hyperlordosis in patients with cerebral palsy treated with posterior spinal fusion: a report of the first two cases. BMC Musculoskelet Disord 2021; 22:217. [PMID: 33622297 PMCID: PMC7903622 DOI: 10.1186/s12891-021-04094-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/17/2021] [Indexed: 12/02/2022] Open
Abstract
Background Spinal deformity is frequently identified in patients with cerebral palsy (CP). As it progresses, tracheal stenosis often develops due to compression between the innominate artery and anteriorly deviated vertebrae at the apex of the cervicothoracic hyperlordosis. However, the treatment strategy for tracheal stenosis complicated by spinal deformity in patients with CP remains unknown. Case presentation This study reports two cases: a 19-year-old girl (case 1) and a 17-year-old girl (case 2), both with CP at Gross Motor Function Classification System V. Both patients experienced acute oxygen desaturation twice within the past year of their first visit to our department. X-ray and computed tomography revealed severe scoliosis and cervicothoracic hyperlordosis causing tracheal stenosis at T2 in case 1 and at T3-T4 in case 2, suggesting that their acute oxygen desaturation had been caused by impaired airway clearance due to tracheal stenosis. After preoperative halo traction for three weeks, both patients underwent posterior spinal fusion from C7 to L5 with Ponte osteotomy and sublaminar taping at the proximal thoracic region to correct cervicothoracic hyperlordosis and thoracolumbar scoliosis simultaneously. Postoperative X-ray and computed tomography revealed that the tracheal stenosis improved in parallel with the correction of cervicothoracic hyperlordosis. Case 1 did not develop respiratory failure 1.5 years after surgery. Case 2 required gastrostomy postoperatively due to severe aspiration pneumonia. However, she developed no respiratory failure related to impaired airway clearance at one-year follow-up. Conclusions We present the first two cases of CP that developed tracheal stenosis caused by cervicothoracic hyperlordosis concomitant with progressive scoliosis and were successfully treated by posterior spinal fusion from C7 to L5. This enabled us to relieve tracheal stenosis and correct the spinal deformity at the same time. Surgeons must be aware of the possibility of coexisting tracheal stenosis in treating spinal deformity in patients with neurological impairment because the surgical strategy can vary in the presence of tracheal stenosis. This study demonstrated that some patients with CP with acquired tracheal stenosis can be treated with spinal surgery.
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Affiliation(s)
- Yuki Taniguchi
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan. .,Department of Next Generation Locomotive Imaging System, The University of Tokyo Hospital, Tokyo, Japan.
| | - Yoshitaka Matsubayashi
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan
| | - So Kato
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan
| | - Fumihiko Oguchi
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan
| | - Ayato Nohara
- Department of Spine Surgery, JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Toru Doi
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan
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Suzuki K, Fujishiro J, Ichijo C, Watanabe E, Tomonaga K, Sunouchi T, Watanabe Y. Prophylactic innominate artery transection to prevent tracheoinnominate artery fistula: a retrospective review of single institution experiences. Pediatr Surg Int 2021; 37:267-273. [PMID: 33388953 DOI: 10.1007/s00383-020-04792-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aimed to investigate the optimal indication and availability of prophylactic innominate artery transection (PIAT). METHODS We retrospectively analyzed the medical records of the patients with neurological or neuromuscular disorders (NMDs) who underwent PIAT. Meanwhile, we originally defined the tracheal flatting ratio (TFR) and mediastinum-thoracic anteroposterior ratio (MTR) from preoperative chest computed tomography imaging and compared these parameters between non-PIAT and PIAT group. RESULTS There were 13 patients who underwent PIAT. The median age was 22 years. PIAT was planned before in one, simultaneously in five, and after tracheostomy or laryngotracheal separation in seven patients. Image evaluations of the brain to assess circle of Willis were performed in all patients. Appropriate skin incisions with sternotomy to expose the innominate artery were made in four patients. All patients are still alive except one late death without any association with PIAT. No neurological complications occurred in any patients. As significant differences (p < 0.01) between two groups were observed for TFR and MTR, objective validity of the indication of PIAT was found. CONCLUSIONS PIAT is safe and tolerable in case of innominate artery compression of the trachea with NMDs. TFR and MTR are useful objective indexes to judge the indication of PIAT.
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Affiliation(s)
- Kan Suzuki
- Department of Pediatric Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Jun Fujishiro
- Department of Pediatric Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Chizue Ichijo
- Department of Pediatric Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Eiichiro Watanabe
- Department of Pediatric Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kotaro Tomonaga
- Department of Pediatric Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tomohiro Sunouchi
- Department of Pediatric Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yasuo Watanabe
- Department of Pediatric Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Lee DJ, Yang W, Propst EJ, Rosenblatt SD, Hseu A, Wolter NE. Tracheo-innominate fistula in children: A systematic review of literature. Laryngoscope 2019; 130:217-224. [PMID: 30632162 DOI: 10.1002/lary.27765] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Tracheo-innominate fistula (TIF) is a rare but fatal complication of tracheotomy. To date, there is a paucity of literature regarding pediatric TIFs. The objectives of this study were to conduct a systematic review of literature on pediatric TIF following tracheotomy and describe three demonstrative cases from our institutional experience. METHODS We conducted a systematic review using MEDLINE, Embase, Cochrane Database of Systematic Reviews, Web of Science, and CINAHL. All studies with pediatric patients (under 18 years of age) who developed TIF following tracheotomy were included. RESULTS Fifty-four publications met inclusion criteria, reporting on 77 cases. The most common indication for tracheotomy was prolonged intubation and the need for ventilatory support (38.6%), with neurological comorbidities being the most common indication (72.7%). The mean time to TIF was 395.7 days (95% confidence interval, 225.9-565.5). Fifty-four patients (70.1%) presented with massive hemorrhage, whereas 18 patients (23.3%) presented with a sentinel bleeding event. The most common diagnostic interventions were computed tomography scan with or without contrast and bronchoscopy (55.8%). A substantial number of patients did not have any investigations (41.6%). Surgical management occurred in 70.1% of patients. Mortality was 38.6% in reported cases with variable follow-up periods. CONCLUSION TIF may occur in long-term tracheostomy-dependent children, contrary to the conventionally described 3-week postoperative period. The mortality may not be as high as previously reported with timely intervention. Our results are limited by inherent risks of bias. Further research including well-designed cohort studies are needed to guide an evidence-based approach to TIF. LEVEL OF EVIDENCE NA Laryngoscope, 130:217-224, 2020.
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Affiliation(s)
- Daniel J Lee
- Department of Otolaryngology-Head & Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Weining Yang
- Department of Otolaryngology-Head & Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Evan J Propst
- Department of Otolaryngology-Head & Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Steven D Rosenblatt
- Department of Otolaryngology-Head & Neck Surgery, Weill Cornell Medicine, New York, New York
| | - Anne Hseu
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Boston, Massachusetts, U.S.A
| | - Nikolaus E Wolter
- Department of Otolaryngology-Head & Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Tokita J, Kung R, Parekh K, Hoffman H. Resection of the innominate artery to prevent an impending tracheoinnominate fistula and to permit tracheotomy in a patient with subglottic stenosis and high-riding innominate. Ann Otol Rhinol Laryngol 2014; 123:658-61. [PMID: 24824081 DOI: 10.1177/0003489414528670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study aimed to determine the long-term viability of innominate artery resection and tracheotomy for a patient at high risk of developing a tracheoinnominate fistula (TIF) in the setting of subglottic stenosis and a high-riding innominate artery. METHODS Chart review with 2-year follow-up. RESULTS A 45-year-old diabetic man with obstructive sleep apnea and multiple admissions for coma and delirium tremens associated with alcohol abuse developed subglottic stenosis. He was found to have a palpable supraclavicular pulse during preoperative examination for a tracheotomy. Computed tomography examination revealed a high-riding innominate artery at the level of stenosis along with granulation tissue and disruption of the cartilaginous trachea, suggesting a high risk of impending TIF. The patient underwent a sternotomy-approach resection of the innominate artery with closure of the distal stump with a sternohyoid muscle flap. Intraoperatively, a plane of adhesions between the posterior innominate artery and trachea was dissected. The anterior tracheal wall appeared calcified but without evidence of erosion of either the trachea or the artery. Six weeks later, a tracheotomy was performed. Follow-up at 27 months did not identify complications from the innominate artery resection. CONCLUSION Resection of the innominate artery is an option for some patients either to address the warning signs of TIF or to permit a tracheotomy to be performed in the presence of a high innominate artery.
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Affiliation(s)
- Joshua Tokita
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Raymond Kung
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Kalpaj Parekh
- Department of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Henry Hoffman
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Hasegawa T, Oshima Y, Hisamatsu C, Matsuhisa H, Maruo A, Yokoi A, Bitoh Y, Nishijima E, Okita Y. Innominate artery compression of the trachea in patients with neurological or neuromuscular disorders. Eur J Cardiothorac Surg 2013; 45:305-11. [DOI: 10.1093/ejcts/ezt346] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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