Successful Surgical Management of Tracheoinnominate Artery Fistula following Temporary Coil Embolization

DOI
  • Koushi Keitarou
    Department of Cardiovascular Surgery, Japanese Red Cross Kyoto Daiichi Hospital
  • Morimoto Kazuki
    Department of Cardiovascular Surgery, Japanese Red Cross Kyoto Daiichi Hospital
  • Kitani Kimitosi
    Department of Cardiovascular Surgery, Japanese Red Cross Kyoto Daiichi Hospital
  • Takahashi Akiyuki
    Department of Cardiovascular Surgery, Japanese Red Cross Kyoto Daiichi Hospital
  • Morishita Hiroyuki
    Department of Diagnostic Radiology, Japanese Red Cross Kyoto Daiichi Hospital

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  • Coil 塞栓が奏功し救命し得た気管切開後気管腕頭動脈瘻の1 例

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Description

Tracheoinnominate artery fistula (TIF) is a relatively rare but often life-threatening complication of tracheostomy. Although controlling the lethal hemorrhage and prompt surgery are indispensable, massive bleeding leads to deterioration of the patient’s respiratory or systemic condition and often prevents early definitive surgical management. We successfully treated a 25-year-old man presenting with TIF 3 years after tracheostomy by performing temporary coil embolization of the innominate artery followed by curative surgery. Massive hemorrhage occurred spontaneously through the tracheostoma while at home. After immediately controlling the hemorrhage using an orotracheal cannula and a hyperinflated cuff, he was transported to our institute by air ambulance. Because he was intolerant to general anesthesia as a result of severe pulmonary insufficiency and general deterioration, he underwent coil embolization of the brachiocephalic artery under local anesthesia. After his general condition had improved a week later, definitive surgical treatment consistings of resection of the erosive innominate artery and repair of the injured trachea was performed. Therefore, palliative coil embolization of the innominate artery followed by curative surgery should be considered in the treatment of TIF.

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