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Hosaka T, Furuno S, Terada M, Hamano Y, Komatsu K, Okubo K, Koyama Y, Suzuki T, Tsuji H, Tamaoka A, Mizutani T. Tracheoarterial fistula in a patient with amyotrophic lateral sclerosis successfully managed by overinflation of the tracheostomy tube cuff alone: a case report. J Med Case Rep 2023; 17:65. [PMID: 36829250 PMCID: PMC9960659 DOI: 10.1186/s13256-023-03799-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/31/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Tracheoarterial fistula is the most devastating complication after tracheostomy, and its mortality, without definitive treatment, approaches 100%. In general, the combination of bedside emergency management, that is, overinflation of the tracheostomy tube cuff, and definitive treatment such as surgical or endovascular intervention is necessary to prevent the poor outcome. Patients with neuromuscular diseases such as amyotrophic lateral sclerosis are susceptible to tracheoarterial fistula because of long-term mechanical ventilation and muscle weakness. CASE PRESENTATION We describe a case of tracheoarterial fistula in a Japanese 39-year-old patient with amyotrophic lateral sclerosis with long-term ventilator management. The patient was clinically diagnosed with a tracheoarterial fistula because of massive bleeding following sentinel hemorrhage. The massive hemorrhage was controlled by overinflation of the tracheostomy tube cuff alone, without definitive treatment. CONCLUSIONS This case suggests overinflation of the tracheostomy tube cuff alone plays an important role, semi-permanently, in the management of tracheoarterial fistula, especially in cases where surgical or endovascular intervention is not indicated. Clinicians taking care of patients with tracheostomy undergoing long-term mechanical ventilation should be aware that tracheoarterial fistula might occur following tracheostomy.
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Affiliation(s)
- Takashi Hosaka
- Division of Clinical Medicine, Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan. .,Department of Internal Medicine, Ibaraki Western Medical Center, University of Tsukuba Hospital/Jichi Medical University Joint Ibaraki Western Regional Clinical Education Center, Chikusei, Ibaraki, 308-0813, Japan. .,Department of Internal Medicine, Ibaraki Western Medical Center, Chikusei, Ibaraki, 308-0813, Japan.
| | - Shintaro Furuno
- Department of Internal Medicine, Ibaraki Western Medical Center, Chikusei, Ibaraki 308-0813 Japan
| | - Makoto Terada
- grid.20515.330000 0001 2369 4728Division of Clinical Medicine, Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575 Japan ,grid.20515.330000 0001 2369 4728Department of Internal Medicine, Ibaraki Western Medical Center, University of Tsukuba Hospital/Jichi Medical University Joint Ibaraki Western Regional Clinical Education Center, Chikusei, Ibaraki 308-0813 Japan ,Department of Internal Medicine, Ibaraki Western Medical Center, Chikusei, Ibaraki 308-0813 Japan
| | - Yumiko Hamano
- Department of Otolaryngology, Ibaraki Western Medical Center, Chikusei, Ibaraki 308-0813 Japan
| | - Kenichi Komatsu
- Department of Internal Medicine, Ibaraki Western Medical Center, Chikusei, Ibaraki 308-0813 Japan
| | - Katsuichiro Okubo
- Department of Internal Medicine, Ibaraki Western Medical Center, Chikusei, Ibaraki 308-0813 Japan
| | - Yasuaki Koyama
- grid.412814.a0000 0004 0619 0044Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, Ibaraki, 305-8576 Japan ,grid.414178.f0000 0004 1776 0989Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Hitachi, Ibaraki 317-0077 Japan
| | - Tetsu Suzuki
- grid.20515.330000 0001 2369 4728Division of Clinical Medicine, Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575 Japan
| | - Hiroshi Tsuji
- grid.20515.330000 0001 2369 4728Division of Clinical Medicine, Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575 Japan
| | - Akira Tamaoka
- grid.20515.330000 0001 2369 4728Division of Clinical Medicine, Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575 Japan
| | - Taro Mizutani
- Department of Anesthesiology, Ibaraki Western Medical Center, Chikusei, Ibaraki 308-0813 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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O'Malley TJ, Jordan AM, Prochno KW, Saxena A, Maynes EJ, Ferrell B, Guy TS, Entwistle JW, Massey HT, Morris RJ, Abai B, Tchantchaleishvili V. Evaluation of Endovascular Intervention for Tracheo-Innominate Artery Fistula: A Systematic Review. Vasc Endovascular Surg 2021; 55:317-324. [PMID: 33529132 DOI: 10.1177/1538574420980625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND While the standard of care for suspected tracheo-innominate artery fistula (TIF) necessitates sternotomy, perioperative mortality remains high. Endovascular interventions have been attempted, but reports have been anecdotal. The aim of this systematic review was to evaluate the outcomes of endovascular management of TIF by pooling the existing evidence. METHODS An electronic database search of Ovid MEDLINE, Scopus, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Controlled Trials Register was performed to identify all studies examining endovascular treatment of TIF. Patients greater than 14 years of age who underwent endovascular intervention for TIF were included. 25 studies consisting of 27 patients met the inclusion criteria. RESULTS 48.1% (13/27) of patients were male and median age was 39.0 [IQR 16.0, 47.5] years. Tracheostomy was present in 96.3% (26/27) of cases. Median duration from tracheostomy to TIF presentation was 2.2 months [0.5, 42.5]. On presentation, 84.6% (22/26) had tracheal hemorrhage, and 22.8% (6/27) were hemodynamically unstable. 96.3% (26/27) underwent covered stent graft placement while 1 patient (3.8%) had coil embolization. 18.5% (5/27) of patients required repeat endovascular intervention for recurrent bleeding, while 11.1% (3/27) required rescue sternotomy. Median hospital length of stay was 30 days [16.0, 46.5], and overall mortality was 29.6% (8/27) with a median follow-up time of 5 months [1.2, 11.5]. CONCLUSION While uncommon, endovascular treatment of TIF may be a feasible alternative to sternotomy. The approach may be useful in those who are unable to undergo surgery or are likely to have adhesions from prior chest operations.
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Affiliation(s)
- Thomas J O'Malley
- Division of Cardiac Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
| | - Andrew M Jordan
- Division of Cardiac Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
| | - Kyle W Prochno
- Division of Cardiac Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
| | - Abhiraj Saxena
- Division of Cardiac Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
| | - Elizabeth J Maynes
- Division of Cardiac Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
| | - Brandon Ferrell
- 12230Georgetown University School of Medicine, Washington, DC, USA
| | - T Sloane Guy
- Division of Cardiac Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
| | - John W Entwistle
- Division of Cardiac Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
| | - H Todd Massey
- Division of Cardiac Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
| | - Rohinton J Morris
- Division of Cardiac Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
| | - Babak Abai
- Division of Vascular and Endovascular Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
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Laswi M, Vega J, Jones K, Lottenberg L. Tracheoinnominate Artery Fistula Treated With Endovascular Stent Graft at a Level I Trauma Center. Cureus 2020; 12:e9710. [PMID: 32944432 PMCID: PMC7489318 DOI: 10.7759/cureus.9710] [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] [Indexed: 12/02/2022] Open
Abstract
Tracheoinnominate artery fistula could be a fatal complication of tracheostomy. Herein, we present the case of a 59-year-old male with sentinel bleeding around the tracheostomy with subsequent workup revealing a tracheoinnominate fistula. Subsequently, the patient was managed with an endovascular approach with a subsequent favorable outcome. We reported an alternative approach to the management of this catastrophic complication in patients who are at high risk for complications from conventional treatment approach.
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Affiliation(s)
- Mujahed Laswi
- General Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Jorge Vega
- Trauma and Acute Care Surgery, Florida Atlantic University/St. Mary's Medical Center, West Palm Beach, USA
| | - Keith Jones
- Vascular Surgery, St. Mary's Medical Center, West Palm Beach, USA
| | - Lawrence Lottenberg
- Surgery, Florida Atlantic University/St. Mary's Medical Center, West Palm Beach, USA
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5
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Palchik E, Bakken AM, Saad N, Saad WAE, Davies MG. Endovascular Treatment of Tracheoinnominate Artery Fistula: A Case Report. Vasc Endovascular Surg 2019. [DOI: 10.1177/10847138062895141] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Tracheoinnominate fistula is a rare but lethal condition that requires emergent surgical intervention to prevent ensuing exsanguinating hemorrhage. In clinical situations where the risk of open surgery is prohibitively high, endovascular repair may provide a life-saving alternative to control hemorrhage and serve as a temporizing or definitive solution based on a given clinical scenario. The authors report successful endovascular repair of the bleeding tracheoinnominate fistula with a stent in a liver transplant patient with high comorbidities and review the current literature.
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Affiliation(s)
- Eugene Palchik
- Center for Vascular Disease, Department of Surgery, University of Rochester, Rochester, New York
| | - Andrew M. Bakken
- Center for Vascular Disease, Department of Surgery, University of Rochester, Rochester, New York
| | - Nael Saad
- Department of Imaging Sciences, University of Rochester, Rochester, New York
| | - Wael A. E. Saad
- Department of Imaging Sciences, University of Rochester, Rochester, New York
| | - Mark G. Davies
- Center for Vascular Disease, Department of Surgery, University of Rochester, Rochester, New York,
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6
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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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7
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Tracheoinnominate Fistula: Endovascular Treatment with a Stent Graft in a 4-Year-Old Child. Ann Vasc Surg 2015; 31:206.e9-206.e12. [PMID: 26597239 DOI: 10.1016/j.avsg.2015.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 07/31/2015] [Accepted: 08/01/2015] [Indexed: 11/20/2022]
Abstract
A 4-year-old boy presented with acute and profuse bleeding at the tracheostomy site. An emergency angiography was performed and identified a pseudoaneurysm at the innominate artery. A selective catheterization of the artery was executed and 2 Advanta V12 balloon-expandable covered stents were implanted in an overlapping manner to occlude the pseudoaneurysm. Final angiography demonstrated patency of the innominate artery and no signs of bleeding. The patient had no postoperative complications and no further bleeding during follow-up. A contrasted computed tomography scan was performed after 20 days and demonstrated no signs of pseudoaneurysm or bleeding. After 4 months, the patient was readmitted to tracheal dilatation and change of T-tube and died of respiratory complications.
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8
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Ahn HY, Son BS, Kim DH. Recurrent Tracheoinnominate Artery Fistula due to Stent Graft Fracture. European J Pediatr Surg Rep 2014; 3:12-4. [PMID: 26171307 PMCID: PMC4487119 DOI: 10.1055/s-0034-1370775] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 12/31/2013] [Indexed: 11/21/2022] Open
Abstract
Tracheoinnominate artery fistula (TIF) is one of the most dangerous complications after tracheostomy, and fetal even after surgical repair. Recently, endovascular stent has been introduced as an option for the treatment of TIF. Unfortunately, endovascular stent repair could not replace the surgery due to rare clinical reports about the long-term follow-up and complications of stent graft. More collection of clinical data are necessary for the evaluation of long-term results. We report a rare case of recurrent TIF due to stent graft fracture after endovascular stent graft insertion in the treatment of TIF, and reviewed the world literature.
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Affiliation(s)
- Hyo Yeong Ahn
- Department of Thoracic and Cardiovascular Surgery, Amidong Seo-gu Pusan National University Hospital, Busan, Republic of Korea
| | - Bong Soo Son
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Do Hyung Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
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9
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Troutman DA, Dougherty MJ, Spivack AI, Calligaro KD. Stent Graft Placement for a Tracheoinnominate Artery Fistula. Ann Vasc Surg 2014; 28:1037.e21-4. [DOI: 10.1016/j.avsg.2013.08.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 08/16/2013] [Accepted: 08/20/2013] [Indexed: 11/24/2022]
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10
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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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11
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Vaidya N, Strauchler D, Guelfguat M. Computed tomography angiography diagnosis of tracheo-innominate fistula: a case report and review of literature. Quant Imaging Med Surg 2013; 3:121-5. [PMID: 23630660 DOI: 10.3978/j.issn.2223-4292.2013.03.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 03/19/2013] [Indexed: 11/14/2022]
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12
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Maeda M, Kubo A, Watanabe M, Sakamoto T, Ayabe J, Tanaka Y. A Case of Tracheoinnominate Artery Fistula after Tracheostomy. ACTA ACUST UNITED AC 2013. [DOI: 10.7887/jcns.22.141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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Nakai M, Sato H, Sato M, Ikoma A, Sanda H, Nakata K, Minamiguchi H, Kawai N, Sonomura T, Nishimura Y, Okamura Y. Tracheo-innominate artery fistula successfully treated by endovascular stent-graft repair. Jpn J Radiol 2012; 31:65-70. [DOI: 10.1007/s11604-012-0143-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 09/21/2012] [Indexed: 12/01/2022]
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14
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Shepard PM, Phillips JM, Tefera G, Hartig GK. Tracheoinnominate fistula: successful management with endovascular stenting. EAR, NOSE & THROAT JOURNAL 2012; 90:310-2. [PMID: 21792799 DOI: 10.1177/014556131109000708] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Tracheoinnominate fistula is a rare complication of tracheostomy that is associated with high rates of morbidity and mortality. Recently, endovascular stents have been described as a viable treatment option for the management of this condition. We report a case of tracheoinnominate fistula in a 40-year-old man that was successfully managed with endovascular stent placement. Our evaluation included bronchoscopy, arteriography, and computed tomographic angiography. Intraoperative localization of the fistula required selective catheterization of the innominate artery.
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Affiliation(s)
- Peter M Shepard
- Southwestern Ear Nose & Throat Associates, Santa Fe, NM 87505, USA.
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15
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Hamaguchi S, Nakajima Y. Two cases of tracheoinnominate artery fistula following tracheostomy treated successfully by endovascular embolization of the innominate artery. J Vasc Surg 2011; 55:545-7. [PMID: 21958569 DOI: 10.1016/j.jvs.2011.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 07/21/2011] [Accepted: 08/03/2011] [Indexed: 12/01/2022]
Abstract
Tracheoinnominate artery fistula (TIF) is a rare but lethal complication of tracheostomy. Treatment has traditionally been surgical, but advances in endovascular technology have led to a few recent reports of therapy with coils. We report 2 cases of TIF with massive hemorrhage that underwent successful treatment with endovascular occlusion. Endovascular repair is less invasive than open surgical repair and usually associated with a shorter recovery period. However, this technique may require multiple coils to inhibit blood flow into the fistula. This procedure should be considered one of the useful treatments for TIF.
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Affiliation(s)
- Shingo Hamaguchi
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan.
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16
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Bleeding around a tracheostomy wound: what to consider and what to do? The Journal of Laryngology & Otology 2009; 123:952-6. [PMID: 19374781 DOI: 10.1017/s002221510900526x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
All patients with bleeding in and around a tracheostomy must be investigated to exclude a serious cause. The overall incidence is approximately 5 per cent of tracheostomies performed in Adult Intensive Care Units (AICU). When bleeding commences more than 72 hours post-operatively, the possibility of a trachea innominate artery fistula needs to be excluded by endoscopic examination of the trachea in an operating theatre environment, with the facility to proceed to exploration of the neck and possibly to sternotomy to enable ligation of the innominate artery. With appropriate recognition, diagnosis, resuscitation and surgical intervention, the associated high death rate of trachea innominate artery fistula can be reduced.
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17
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Guimaraes M, Schönholz C, Phifer T, D'Agostino H. Endovascular Repair of a Tracheoinnominate Fistula with a Stent Graft. Vascular 2008; 16:287-90. [DOI: 10.2310/6670.2008.00045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Massive bleeding from a tracheostomy developed in a 65-year-old woman with stroke after successful conservative management of a minor tracheostomy bleeding episode. Temporary hemostasis was achieved, and angiography showed a tracheoinnominate fistula (TIF), a rare complication of tracheostomy. Open surgery was contraindicated in this patient, so endovascular repair using a stent graft was performed. Permanent hemostasis was obtained, and there were no immediate complications from the procedure. The patient never recovered from her stroke and died 2 weeks later. The endovascular approach may be a feasible alternative to surgical repair of TIF, especially in patients unable to tolerate an open procedure.
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Affiliation(s)
- Marcelo Guimaraes
- *Heart and Vascular Center, Medical University of South Carolina, Charleston, SC; Departments of †Vascular Surgery and ‡Radiology, Louisiana State University, Shreveport, LA
| | - Claudio Schönholz
- *Heart and Vascular Center, Medical University of South Carolina, Charleston, SC; Departments of †Vascular Surgery and ‡Radiology, Louisiana State University, Shreveport, LA
| | - Travis Phifer
- *Heart and Vascular Center, Medical University of South Carolina, Charleston, SC; Departments of †Vascular Surgery and ‡Radiology, Louisiana State University, Shreveport, LA
| | - Horacio D'Agostino
- *Heart and Vascular Center, Medical University of South Carolina, Charleston, SC; Departments of †Vascular Surgery and ‡Radiology, Louisiana State University, Shreveport, LA
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18
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Kato K, Suzuki N, Aoki M, Warita H, Jin K, Itoyama Y. [Massive bleeding from tracheoarterial fistula in an amyotrophic lateral sclerosis patient treated with long-term invasive ventilation: an autopsy case report]. Rinsho Shinkeigaku 2008; 48:60-2. [PMID: 18386635 DOI: 10.5692/clinicalneurol.48.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report a 43-year-old woman with familial amyotrophic lateral sclerosis (FALS) who died of massive bleeding from a tracheoarterial fistula. Four years after the onset of the disease, she received invasive ventilation by tracheostomy because of respiratory failure. Four years and 7 months later, she showed an abrupt hemorrhage from the tracheostomy and died. The postmortem examination revealed a fistulous tract between the tracheal mucosal ulcer and the brachiocephalic trunk. The ulcer was in close proximity to the tracheostomy tube. In order to avoid such unexpected complications, we should observe the contact site between the tracheal mucosa and the tracheal tube in chronic tracheostomy patients.
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Affiliation(s)
- Kazuhiro Kato
- Department of Neurology, Tohoku University School of Medicine
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19
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Cohen JE, Klimov A, Rajz G, Paldor I, Spektor S. Exsanguinating tracheoinnominate artery fistula repaired with endovascular stent-graft. ACTA ACUST UNITED AC 2008; 69:306-9. [PMID: 17586021 DOI: 10.1016/j.surneu.2006.12.060] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Accepted: 12/27/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Tracheoinnominate artery fistula is a relatively rare but life-threatening complication of tracheostomy. Peristomal bleed or hemoptysis may be massive and usually fatal if treatment is not instituted immediately. CASE DESCRIPTION We report the case of a 40-year-old woman who sustained surgical evacuation of a brainstem cavernoma and developed a massive hemoptysis 13 days after a percutaneous tracheostomy. Because of the patient's poor clinical condition, endovascular repair of the arterial injury was decided. The innominate artery was successfully repaired by means of urgent stent-graft placement. CONCLUSIONS We believe that, if technically feasible, stent-graft placement can be a valuable therapeutic alternative for this dramatic condition. Physicians in charge of tracheostomized patients and neurointerventionalists should be familiar with this management strategy.
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Affiliation(s)
- José E Cohen
- Department of Neurosurgery, Hadassah Hebrew University Hospital, 91120 Jerusalem, Israel.
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Sorial E, Valentino J, Given CA, Endean ED, Minion DJ. The emergency use of endografts in the carotid circulation to control hemorrhage in potentially contaminated fields. J Vasc Surg 2007; 46:792-8. [PMID: 17903657 DOI: 10.1016/j.jvs.2007.05.052] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2007] [Accepted: 05/29/2007] [Indexed: 11/18/2022]
Abstract
We report our experience with the use of endoluminal grafts to control emergency bleeding in two patients with tracheoinnominate fistulas and three patients with carotid blowouts. Systemic infectious complications were not seen. However, rebleeding occurred in one patient, and extensive stent coverage to control bleeding was required in a second. Survival was usually limited by the patient's cancer. There was one long-term survivor without cancer whose tracheostomy was placed for neurologic compromise. A review of the literature for similar cases identified 18 additional endografts placed for carotid blowout and 3 placed for tracheoinnominate fistulas. Overall, infectious complications occurred in only two patients, whereas rebleeding occurred in eight patients. On the basis of these findings, we believe that endografts are useful to control emergency hemorrhage in these two pathologies because treatment is usually palliative, given the poor survival secondary to the underlying disease. However, more extensive graft coverage may be necessary considering the erosive nature of these processes.
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Affiliation(s)
- Ehab Sorial
- Department of Surgery, University of Kentucky Medical Center, Lexington, KY 40536, USA
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