Operative technique for tracheo-innominate artery fistula repair.
Tracheo-innominate artery fistula is fatal unless treated surgically. We describe our surgical approach and results in seven patients. The average patient age was 15.7 years; all patients had prior severe neurological deficits. Three of seven patients were in hemorrhagic shock; control of preoperative bleeding was achieved with tracheostomy tube cuff overinflation. The innominate artery and the trachea were exposed through a collar incision and partial upper sternotomy. The innominate artery was divided at the aortic arch and at the bifurcation, with one exception. Cerebral blood flow was monitored by the blood pressure difference in the bilateral upper extremities and by near-infrared spectroscopy. The tracheal fistula was left adherent to the innominate artery in all but one patient. All patients were discharged without new neurologic deficits or severe morbidity. Overall survival was 84% at 37 months, without any vascular, tracheal, or neurological events.
Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, Saga, Japan. Electronic address: furukako@cc.saga-u.ac.jp.
Kojiro
K
Furukawa
Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, Saga, Japan.
Keiji
K
Kamohara
Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, Saga, Japan.
Manabu
M
Itoh
Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, Saga, Japan.
Hiroyuki
H
Morokuma
Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, Saga, Japan.
Shigeki
S
Morita
D000293:Adolescent; D000328:Adult; D001794:Blood Pressure; D016122:Brachiocephalic Trunk / Q000503:physiopathology / Q000601:surgery*; D002560:Cerebrovascular Circulation; D015505:Chest Tubes; D002648:Child; D002675:Child, Preschool; D005260:Female; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods; D016156:Respiratory Tract Fistula / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D019265:Spectroscopy, Near-Infrared; D056346:Sternotomy; D019616:Thoracic Surgical Procedures / Q000295:instrumentation; D014133:Tracheal Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014139:Tracheostomy / Q000295:instrumentation; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014656:Vascular Surgical Procedures; D055815:Young Adult