Successful treatment of tracheoinnominate artery fistula following tracheostomy in a patient with cerebrovascular disease

Abstract

Tracheoinnominate artery fistula is a critical complication of tracheostomy. The most important factors influencing patient outcome are prompt diagnosis, immediate control of bleeding with a patent airway, and emergency operation with or without interruption of the innominate artery. Here, we report a case of tracheoinnominate artery fistula in a 40-year-old woman with cerebrovascular accident who was successfully managed with an aorta-axillary artery bypass.

Keywords: Complication; Tracheoinnominate artery fistula; Tracheostomy.

Fig. 1

A 46-year-old woman visited the emergency room with left hemiparesis and dysarthria. Brain computed tomography demonstrated an intracerebral hemorrhage at the right basal ganglia (A). Three days later, a chest X-ray revealed diffuse haziness in both lung fields induced by aspiration pneumonia (B).

Fig. 2

Contrast enhanced thoracic computed tomography demonstrated that an overinflated endotracheal tube cuff (white arrowhead) was controlling bleeding from fistula site by compressing the innominate artery (white arrow).

Fig. 3

An angiogram of the innominate artery demonstrated outpouching near the right common carotid artery (black arrow). For this reason, we selected a surgical management instead of an endovascular option.

Fig. 4

Anterior (A) and posterior (B) views of thoracic computed tomographic angiography with three-dimensional reconstruction show good perfusion of the carotid artery, subclavian artery, and intracranial circulation after aorta-axillary artery bypass using a synthetic graft. Aorta-axillary artery graft bypass is visible between two white arrow heads and there is narrow at the junction between the innominate artery and the common carotid artery (white arrow) owing to an adjacent fistula site.