title: Tracheo-innominate artery fistula with severe motor and intellectual disability: incidence and therapeutic management.
abstract: OBJECTIVE
  Tracheo-innominate artery fistula (TIF) is a rare but life-threatening complication following tracheostomy or tracheoesophageal diversion (TED). Although successful surgical intervention for TIF has been reported, few studies have been performed in patients with severe motor and intellectual disability (SMID). Therefore, we aimed to analyze TIF in patients with SMID to clarify the clinical variables predicting the occurrence and adequate management for lifesaving of TIF.
  
  
  METHODS
  We retrospectively reviewed the records of patients with SMID undergoing surgical tracheostomy and TED between 2006 and 2012 and identified those with TIF. When TIF occurred, we obtained the clinical status and emergency management.
  
  
  RESULTS
  Of 70 patients who underwent tracheostomy or TED during the study period, three patients had TIFs; in one case, TIF was avoided by ligation of the innominate artery before TED. The incidence of TIF in those undergoing tracheostomy and TED was 2.3% and 7.4%, respectively. The interval between tracheostomy and TIF was 14-50 months.
  
  
  CONCLUSIONS
  Patients with SMID may have an increased risk of TIF. Prompt diagnosis and surgical intervention to control the bleeding is the only effective management at present.
authors.affiliation: Department of Otolaryngology, Sapporo Medical University School of Medicine, S1W16, Chuo-ku, Sapporo 060-8556, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Kurose
authors.affiliation: Department of Otolaryngology, Sapporo Medical University School of Medicine, S1W16, Chuo-ku, Sapporo 060-8556, Japan. Electronic address: kent@sapmed.ac.jp.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Takano
authors.affiliation: Department of Otolaryngology, Hokkaido Medical Center for Child Health andRehabilitation, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Mitsuzawa
authors.affiliation: Department of Otolaryngology, Sapporo Medical University School of Medicine, S1W16, Chuo-ku, Sapporo 060-8556, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Himi
mesh_terms: D016122:Brachiocephalic Trunk / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic; D004947:Esophagus / Q000601:surgery; D005260:Female; D006801:Humans; D007103:Immobilization; D007223:Infant; D008607:Intellectual Disability / Q000150:complications*; D008026:Ligation; D008297:Male; D011183:Postoperative Complications; D011782:Quadriplegia / Q000150:complications*; D016156:Respiratory Tract Fistula / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D014132:Trachea / Q000601:surgery; D014133:Tracheal Diseases / Q000209:etiology / Q000628:therapy*; D014139:Tracheostomy / Q000009:adverse effects; D016157:Vascular Fistula / Q000209:etiology / Q000628:therapy*
keywords: Severe motor and intellectual disability; Tracheo-innominate artery fistula; Tracheoesophageal diversion; Tracheostomy