Tracheo-innominate artery fistula with continuous bleeding successfully treated through the suprasternal approach: a case report

• Published in: Journal of cardiothoracic surgery 2020-02, Vol.15 (1), p.41-41, Article 41
• Main Authors: Kaneko, Shotaro, Uchida, Keiji, Karube, Norihisa, Kasama, Keiichiro, Minami, Tomoyuki, Cho, Tomoki, Izubuchi, Ryo, Fushimi, Kenichi, Yabu, Naoto, Goda, Motohiko, Masuda, Munetaka
• Format: Article
• Language: English
• Subjects: Balloon catheter; Balloon catheters; Bleeding; Care and treatment; Carotid arteries; Case Report; Case reports; Catheters; Continuous bleeding; Fistula; Fistulae; Fistulas; Health aspects; Infections; Medical instruments; Ostomy; Patients; Retirement benefits; Suprasternal approach; Surgery; Tracheo-innominate artery fistula; Tracheotomy; Vascular fistula; Veins & arteries
• ISSN: 1749-8090; 1749-8090
• DOI: 10.1186/s13019-020-1080-y

Tracheo-innominate artery fistula (TIF) is a rare but fatal complication occurring after tracheotomy. Brachiocephalic trunk transection, one of the surgical treatments for TIF, is mostly associated with a full or partial median sternotomy. We describe a case of TIF with continuous bleeding, which was successfully treated with brachiocephalic trunk transection through a collar incision without the need for median sternotomy. Case 1. An 18-year-old man was referred to our hospital with bleeding from a tracheal stoma, which had ceased prior to admission. TIF was suspected after examination. Innominate artery transection was performed through a collar incision. TIF was not revealed when we cut the innominate artery anterior wall open; therefore, we opted for preventive surgical intervention. The post-operative course was uneventful, and the patient was asymptomatic at the 3-year follow-up. Case 2. A 14-year-old male patient was admitted to our hospital with bleeding from a tracheal stoma, and TIF was suspected after examination. There was persistent bleeding when the cuff of the tracheotomy tube was deflated. Brachiocephalic trunk transection was performed through a collar incision using balloon occlusion. The post-operative course was uneventful, and rebleeding has not occurred 2 years later. Brachiocephalic trunk transection without any median sternotomy may offer the benefits of post-operative infection prevention. In patients with suspected continuous bleeding, using a balloon catheter may be a safe and effective method of treatment.