Preventive Innominate Artery Transection for a High-Risk Case of Tracheo-Innominate Artery Fistula

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  • Mizumoto Masahiro
    Second Department of Surgery, Yamagata University Faculty of Medicine
  • Uchida Tetsuro
    Second Department of Surgery, Yamagata University Faculty of Medicine
  • Kuroda Yoshinori
    Second Department of Surgery, Yamagata University Faculty of Medicine
  • Yamashita Atsushi
    Second Department of Surgery, Yamagata University Faculty of Medicine
  • Oba Eiichi
    Second Department of Surgery, Yamagata University Faculty of Medicine
  • Hayashi Jun
    Second Department of Surgery, Yamagata University Faculty of Medicine
  • Nakai Shingo
    Second Department of Surgery, Yamagata University Faculty of Medicine
  • Kobayashi Kimihiro
    Second Department of Surgery, Yamagata University Faculty of Medicine
  • Ochiai Tomonori
    Second Department of Surgery, Yamagata University Faculty of Medicine

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  • 気管腕頭動脈瘻ハイリスク例に対する予防的腕頭動脈離断術

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<p>An 18-year-old man with hypoxic encephalopathy was admitted because of recurrent minor bleeding a tracheal stoma, which was suspected as a tracheo-innominate artery fistula (TIF). He had undergone tracheostomy and gastrostomy 2 years prior and had mild opisthotonos and scoliosis. Although tracheal endoscopy showed no tracheal mucosal erosion, necrosis, or granulation tissue formation, contrast-enhanced computed tomography (CT) revealed a close contact between the innominate artery and the anterior wall of the trachea, and an equal height between the innominate artery and the tip of the tracheal cannula. Magnetic resonance angiography of the head showed dominant intracranial blood flow from the left internal carotid and vertebral arteries. Preventive innominate artery transection through the supra-sternal approach without sternotomy or reconstruction of the innominate artery was performed for this high-risk case of TIF. The patient's postoperative course was uneventful. Postoperative CT revealed that the innominate artery was transected and isolated from the site of tracheostomy. The preserved connection between the right common carotid and subclavian artery at the distal sutured stump helped maintain blood flow in the right internal and middle cerebral arteries. The patient was discharged on postoperative day 9 without any new neurological complications or bleeding from a tracheal stoma. TIF is a rare but fatal complication after laryngotracheal separation or tracheostomy. It is important to prevent the onset of TIF, however, there are no criteria for preventive innominate artery transection. Our preventive innominate artery transection through the supra-sternal approach is considered as one of the useful surgical treatment for high-risk cases of TIF accompanied by severe neuromuscular disorders.</p>

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