title: [Experience of 3 successfully treated cases of tracheo-innominate artery fistula and significance of preventive surgery].
abstract: Tracheo-innominate artery fistula (TIF) is a rare but fatal complication after tracheostomy. Necessary lifesaving measures include proper ventilation, temporary hemostasis, and surgery. Recently, we successfully managed 3 cases of TIF. Ventilation and temporary hemostasis were secured by a long endotracheal tube and overinflated cuff. Division of the innominate artery, restoration of the tracheal fistula with an autologous pericardial patch or direct closure, and aorto-innominate bypass grafting or extra-anatomical bypass grafting with a polytetrafluoroethylene (PTFE) graft were performed through an emergency median sternotomy. All 3 patients recovered with no problems. After TIF occurs, the patient's condition rapidly worsens, and the risk of bacterial contamination in the operative field may increase. Surgical intervention should be performed for patients with tracheal stenosis who are judged to be at high risk for TIF. This preventive surgery includes bypass grafting to divide the innominate artery and partial resection of the anterior bony thorax(upper sternum, medial part of clavicles, and anterior part of upper ribs if necessary). We believe that this procedure will improve tracheal stenosis and minimize the risk of TIF. Thus far, 10 patients have undergone this operation, and their mid-term results are satisfactory.
authors.affiliation: Department of Cardiovascular Surgery, Kagawa Children's Hospital, Zentsuji, Japan.
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Kawahito
authors.forename: Shinji
authors.initials: S
authors.lastname: Takano
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Egawa
authors.forename: Homare
authors.initials: H
authors.lastname: Yoshida
mesh_terms: D000293:Adolescent; D000328:Adult; D016122:Brachiocephalic Trunk; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D016156:Respiratory Tract Fistula / Q000517:prevention & control / Q000601:surgery*; D014133:Tracheal Diseases / Q000517:prevention & control / Q000601:surgery*; D014139:Tracheostomy; D016157:Vascular Fistula / Q000517:prevention & control / Q000601:surgery*