Tracheo Innominate Artery Fistula

Excerpt

Tracheoinnominate fistula (TIF) is a rare but life-threatening complication most frequently associated with tracheostomy, carrying a high risk of massive hemorrhage and mortality. This condition has also been reported following tracheal resection and reconstruction, penetrating neck trauma, and migration of orthopedic hardware, and, rarely, after endovascular stent graft placement. The innominate artery (brachiocephalic artery or trunk) is 1 of the 3 principal branches of the aortic arch. This artery courses cephalad and anterior to the trachea, deep to the sternum, ultimately bifurcating into the right common carotid and subclavian arteries. The proximity to the trachea makes it vulnerable to injury during tracheostomy and other endotracheal procedures. A fistula may develop from direct intraoperative injury or as a delayed complication due to pressure necrosis from the tracheostomy tube or cuff, resulting in catastrophic hemorrhage.