Trachea-innominate artery fistula and concomitant critical cerebrovascular disease.
To avoid the laborious task of investigating the cerebrovascular circulation in the midst of a trachea-innominate artery fistula, we strongly recommend preoperative cerebrovascular investigations in all patients about to undergo mediastinal tracheostomy. Paramount to this dictum remains the possibility of asymptomatic cerebrovascular disease. Inadequate preoperative cerebrovascular assessment may result in, as described in this report, the possibility of significant postoperative neurologic morbidity or mortality. Angiography should assist the surgeon in deciding which method of cerebral arterial reconstruction is best suited to the individual circumstance. We recommend the avoidance of innominate artery reconstruction even with the interposition of autologous tissues, as the operative field remains grossly infected.
Black
M D
MD
Division of Thoracic Surgery, Ottawa Civic Hospital, University of Ottawa, Ontario, Canada.
Shamji
F M
FM
Todd
T R
TR
D000368:Aged; D001807:Blood Vessel Prosthesis; D016122:Brachiocephalic Trunk; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000150:complications* / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D005402:Fistula / Q000150:complications / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D014132:Trachea / Q000601:surgery; D014133:Tracheal Diseases / Q000150:complications / Q000209:etiology / Q000601:surgery*; D014139:Tracheostomy / Q000009:adverse effects; D014715:Vertebrobasilar Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging