title: Stent graft placement for a tracheoinnominate artery fistula.
abstract: A 68-year-old woman with ventilator-dependent respiratory failure and multiple comorbidities developed acute massive hemoptysis. Computed tomographic angiogram revealed a 3.9-cm pseudoaneurysm arising from the innominate artery abutting the trachea. The patient was successfully treated with stent graft insertion via the right common carotid artery, with exclusion of the aneurysm from the proximal innominate to the right common carotid artery, with ligation of the proximal right subclavian artery and right common carotid to subclavian artery bypass. The patient remained medically stable for 3 months after the procedure with no evidence of endoleak or infection. She then developed recurrent hemoptysis with fatal cardiac arrest. Open surgical repair has been the treatment of choice for tracheoinnominate artery fistula. However, direct repair confers a high mortality risk. Endovascular exclusion offers a less invasive treatment option for tracheoinnominate artery fistula and can serve as a bridge for patients with potential for becoming better surgical candidates.
authors: Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, PA.
authors: Douglas A
authors: DA
authors: Troutman
authors: Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, PA. Electronic address: Mattdough@aol.com.
authors: Matthew J
authors: MJ
authors: Dougherty
authors: Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, PA.
authors: Adam I
authors: AI
authors: Spivack
authors: Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, PA.
authors: Keith D
authors: KD
authors: Calligaro
mesh_terms: D000368:Aged; D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D016122:Brachiocephalic Trunk / Q000000981:diagnostic imaging / Q000601:surgery*; D017536:Carotid Artery, Common / Q000601:surgery; D057510:Endovascular Procedures / Q000295:instrumentation; D017809:Fatal Outcome; D005260:Female; D006323:Heart Arrest; D006469:Hemoptysis / Q000209:etiology; D006801:Humans; D008026:Ligation; D011474:Prosthesis Design; D011859:Radiography; D012008:Recurrence; D016156:Respiratory Tract Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D015607:Stents; D013348:Subclavian Artery / Q000601:surgery; D014133:Tracheal Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D014139:Tracheostomy / Q000009:adverse effects*; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*