title: Tracheo-innominate fistula formation; a rare complication of tracheostomy.
abstract: Fistula formation between trachea and the innominate artery is a life-threatening complication of tracheostomy. The overall incidence of tracheo-innominate artery fistula (TIF) has been reported to be 0.3- 0.7%. Several such cases occur in the first three weeks after tracheostomy and its hallmark is massive arterial bleeding either through or around the tracheostomy site. Mechanisms of fistula formation include mucosal necrosis due to pressure exerted by the cuff of the tracheostomy tube, high-cuff pressure, abnormally high innominate artery, low-placed tracheostomy (4 tracheal ring or below) and excessive head movement. Immediate surgical attention is the key to managing this fatal complication. We present herein patient who developed TIF and died as a consequence of massive haemorrhage into the tracheobronchial tree and asphyxia. It is a rare case and to our knowledge no case of TIF or any case series concerning this rare complication has recently been reported from Pakistan.
authors.affiliation: 14th Year Students, Department of Otolaryngology Ziauddin University Hospital, Karachi.
authors.forename: Farah
authors.initials: F
authors.lastname: Shaukat
authors.forename: Khalid
authors.initials: K
authors.lastname: Iqbal
authors.forename: Sohail
authors.initials: S
authors.lastname: Akhtar
authors.forename: Ali
authors.initials: A
authors.lastname: Ammar
mesh_terms: D016122:Brachiocephalic Trunk; D005260:Female; D006801:Humans; D016156:Respiratory Tract Fistula / Q000209:etiology*; D014133:Tracheal Diseases / Q000209:etiology*; D014139:Tracheostomy / Q000009:adverse effects; D016157:Vascular Fistula / Q000209:etiology*; D055815:Young Adult