Tracheo-innominate artery fistula successfully treated by endovascular stent-graft repair.
We report two patients who developed a tracheo-innominate artery fistula (TIF) after tracheostomy. Contrast-enhanced computed tomography revealed a pseudoaneurysm of the innominate artery protruding into the trachea. Stent grafts were deployed for the innominate artery via two different access routes: the transfemoral approach and the right carotid artery approach. Endovascular stent-graft repair resulted in complete exclusion of the TIF and control of the bleeding from the tracheal stoma. At 12- and 16-month follow-ups, neither patient had clinical signs of graft infection, recurrent fistulization, or ischemic complications. It is feasible and useful to employ the carotid artery approach for stent-graft implantation in patients who have vascular anatomical limitations for the transfemoral approach. Endovascular repair of TIF by stent grafting is a minimally invasive treatment that can be tolerated by patients in poor clinical condition, and is a feasible alternative to surgical treatment.
Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama 641-8510, Japan. momonga@wakayama-med.ac.jp
Motoki
M
Nakai
Hirotatsu
H
Sato
Morio
M
Sato
Akira
A
Ikoma
Hiroki
H
Sanda
Kohei
K
Nakata
Hiroki
H
Minamiguchi
Nobuyuki
N
Kawai
Tetsuo
T
Sonomura
Yoshiharu
Y
Nishimura
Yoshitaka
Y
Okamura
D000328:Adult; D000368:Aged; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D016122:Brachiocephalic Trunk / Q000000981:diagnostic imaging / Q000601:surgery*; D003287:Contrast Media; D006801:Humans; D008297:Male; D015607:Stents; D014057:Tomography, X-Ray Computed; D014133:Tracheal Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D014139:Tracheostomy / Q000009:adverse effects*; D016157:Vascular Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*
D003287:Contrast Media