Trachea-innominate artery fistula: retrospective comparison of treatment methods.
A fistula between the trachea and the innominate artery, a potentially fatal complication of tracheostomy, can be managed successfully. We have derived several guidelines from our experience with one such case and from a review of the 36 cases reported in the literature over the last decade. Diagnosis must be established before exsanguination occurs. Bronchoscopy and angiography are often nondiagnostic. Control of hemorrhage and a patent airway are the initial goals of treatment. Interruption of the innominate artery is the definitive treatment, with a low rebleeding rate (7%, 1/14 cases) and good long-term survival (64%, 9/14 cases). Maintenance of continuity of the innominate artery is contraindicated, because of a high rebleeding rate (60%, 6/10 cases) and poor long-term survival (10%, 1/10 cases). There is no convincing evidence that interruption of the innominate artery causes significant neurologic or vascular compromise.
Yang
F Y
FY
Department of Surgery, University of North Carolina Memorial Hospital, Chapel Hill 27514.
Criado
E
E
Schwartz
J A
JA
Keagy
B A
BA
Wilcox
B R
BR
D000328:Adult; D016122:Brachiocephalic Trunk / Q000601:surgery*; D005402:Fistula / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008026:Ligation; D008297:Male; D012189:Retrospective Studies; D014133:Tracheal Diseases / Q000209:etiology* / Q000601:surgery; D014139:Tracheostomy / Q000009:adverse effects*