title: Management of trachea--innominate artery fistula.
abstract: The case histories of three patients with trachea-innominate artery fistula are presented. Low tracheostomy was the etiologic factor producing the fistula in two patients. In both cases, the neck was hyperextended by placing a large roll behind the patient's shoulders and thereby elevating the trachea out of the mediastinum. In one patient a balloon cuff eroded the innominate artery. Management of these patients includes control of hemorrhage by cuff overinflation and/or by endotracheal intubation and packing of the tracheostomy site. The best surgical approach is via a right anterior thoracotomy and a separate neck incision to isolate the blood vessels involved. Median sternotomy should be avoided to prevent mediastinal infection and sternal dehiscence. Carotid stump pressures are a useful guide to determine the efficacy of innominate artery ligation. One patient was saved and is a long-term survivor.
mesh_terms: D000328:Adult; D001794:Blood Pressure; D001807:Blood Vessel Prosthesis; D016122:Brachiocephalic Trunk / Q000601:surgery*; D002339:Carotid Arteries / Q000601:surgery; D005260:Female; D005402:Fistula / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery; D013348:Subclavian Artery / Q000601:surgery; D013903:Thoracic Surgery; D013909:Thorax / Q000601:surgery; D014133:Tracheal Diseases / Q000601:surgery*; D014140:Tracheotomy / Q000009:adverse effects*