Tracheoinnominate artery fistula after laryngotracheal separation: prevention and management.
OBJECTIVE
Tracheoinnominate artery fistula (TIF) is an often fatal complication of laryngotracheal separation (LTS) for which there has been no systematic therapeutic strategy for prevention or management of TIF. The aim of this study was to establish such a strategy based on our clinical experience.


METHODS
From 2000 to 2010, 14 patients received LTS. We reviewed these patients to develop a therapeutic approach to prevent or manage TIF.


RESULTS
Three patients had major bleeding, and another 3 received preventive treatment before major bleeding. In the major bleeding group, 1 patient died of choking from uncontrollable hemorrhage, but the others were rescued by brachiocephalic trunk separation and/or endovascular embolization. At operation, median sternotomy with its high risk of mediastinitis was avoided. In the preventive treatment group, prophylactic brachiocephalic trunk separation was performed for 2 patients because their severe scoliosis narrowed the mediastinum, compressing the innominate artery on computed tomography. Another avoided major bleeding by converting the tracheostomy tube to a length-adjustable type.


CONCLUSIONS
Tracheoinnominate artery fistula is a dramatic, often lethal complication. The strategic approach should be designed to prevent it and includes evaluation of the spinal deformity on computed tomography, brachiocephalic trunk separation at the same time as LTS, and recognizing the importance of "herald" or warning minor bleeds.
Department of Paediatric Surgery, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan. S-hideaki@marianna-u.ac.jp
Hideaki
H
Sato
Hirokazu
H
Kawase
Shigeyuki
S
Furuta
Hideki
H
Shima
Munechika
M
Wakisaka
Hiroaki
H
Kitagawa
D000293:Adolescent; D001238:Asphyxia Neonatorum / Q000150:complications; D016122:Brachiocephalic Trunk / Q000601:surgery; D001925:Brain Damage, Chronic / Q000150:complications; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006489:Hemostatic Techniques; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007830:Larynx / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000628:therapy; D053120:Respiratory Aspiration / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D016156:Respiratory Tract Fistula / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy; D012600:Scoliosis / Q000150:complications; D014132:Trachea / Q000601:surgery*; D016157:Vascular Fistula / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy; D055815:Young Adult