Tracheo-innominate artery fistula: Diagnosis and surgical management.
BACKGROUND
Tracheo-innominate artery fistula (TIF) is a rare and fatal complication after tracheostomy. The diagnosis, treatment, and possible prevention of this disease are discussed in this study.


METHODS
From 1976 to 2008, 14 patients with TIF were studied retrospectively.


RESULTS
All patients underwent open surgical tracheostomy. Before TIF, herald events occurred in 10 patients (8 had slight hemoptysis and 2 had innominate artery exposure). When TIF occurred, bedside aid was administered, and 5 patients lived long enough to reach the operating room. Four patients accepted median sternotomy and ligation of innominate arteries. After surgery, mediastinal infection caused the rebleeding and death of 3 patients. In conducting follow-up for 11 months, the last patient was still alive without neurological complications. The survival rate was only 7.1%.


CONCLUSIONS
Prompt diagnosis and surgical intervention can save the life of a patient with TIF. Prevention is vital because of the high mortality of this disease.
Department of Head and Neck Surgery, Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Xiao-lei
XL
Wang
Zhen-gang
ZG
Xu
Ping-zhang
PZ
Tang
Yue
Y
Yu
D000328:Adult; D000368:Aged; D001237:Asphyxia / Q000209:etiology; D016122:Brachiocephalic Trunk / Q000293:injuries / Q000601:surgery; D001999:Bronchoscopy; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000150:complications; D006469:Hemoptysis / Q000209:etiology; D006489:Hemostatic Techniques; D006801:Humans; D007239:Infections / Q000209:etiology; D008297:Male; D008477:Mediastinal Diseases / Q000209:etiology; D008875:Middle Aged; D016156:Respiratory Tract Fistula / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D056346:Sternotomy; D014133:Tracheal Diseases / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D014139:Tracheostomy / Q000009:adverse effects*; D016157:Vascular Fistula / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D055815:Young Adult
complications; diagnosis; surgery; tracheo-innominate artery fistula; tracheostomy