Exsanguinating tracheoinnominate artery fistula repaired with endovascular stent-graft.
BACKGROUND
Tracheoinnominate artery fistula is a relatively rare but life-threatening complication of tracheostomy. Peristomal bleed or hemoptysis may be massive and usually fatal if treatment is not instituted immediately.


METHODS
We report the case of a 40-year-old woman who sustained surgical evacuation of a brainstem cavernoma and developed a massive hemoptysis 13 days after a percutaneous tracheostomy. Because of the patient's poor clinical condition, endovascular repair of the arterial injury was decided. The innominate artery was successfully repaired by means of urgent stent-graft placement.


CONCLUSIONS
We believe that, if technically feasible, stent-graft placement can be a valuable therapeutic alternative for this dramatic condition. Physicians in charge of tracheostomized patients and neurointerventionalists should be familiar with this management strategy.
Cohen
José E
JE
Department of Neurosurgery, Hadassah Hebrew University Hospital, 91120 Jerusalem, Israel. jcohenns@yahoo.com
Klimov
Alex
A
Rajz
Gustavo
G
Paldor
Iddo
I
Spektor
Sergei
S
D000328:Adult; D016122:Brachiocephalic Trunk / Q000473:pathology*; D001932:Brain Neoplasms / Q000601:surgery; D001933:Brain Stem / Q000601:surgery; D005260:Female; D005402:Fistula / Q000473:pathology* / Q000601:surgery*; D020786:Hemangioma, Cavernous, Central Nervous System / Q000601:surgery; D006469:Hemoptysis / Q000209:etiology / Q000601:surgery; D006801:Humans; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage / Q000601:surgery*; D015607:Stents; D014132:Trachea; D014139:Tracheostomy / Q000009:adverse effects; D014656:Vascular Surgical Procedures / Q000379:methods*