Tracheo-innominate Artery Fistula in a Complicated Penetrating Neck Trauma: A Successfully Managed Rare Complication of Low Tracheotomy

Abstract

Tracheo-innominate artery fistula is a rare complication of tracheotomy with very high mortality rate. Only a few patients survive this complication as reported in the literature. Here we report the case of a 54-year-old gentleman who presented to the emergency department with a history of penetrating neck trauma following a road traffic accident. Neck exploration and tracheotomy were done to secure the airway. After two weeks, the patient had an episode of massive stomal bleed for which he was taken to the operating room and re-explored. A tracheo-innominate artery fistula was detected, and right side aorto-carotid and right side aorto-subclavian anastomoses were done using reversed saphenous vein graft with interruption of flow. Following a successful surgery, the patient was decannulated later, and now lives a healthy normal life. Early diagnosis and immediate intervention are the key in managing this complication. Bedside management also plays a vital role.

Keywords: Tracheotomy; complication; hemorrhage; innominate artery; oesophageal perforation.

Figure 1

Anastomosis of right carotid aorta with reversed saphenous vein (white arrow)

Figure 2

Anastomosis of right subclavian aorta with reversed saphenous vein (white arrow)

Figure 3

Computed tomography angiography done at sixth-month follow-up showing patent anastomosis (white arrow)