Trachea-innominate artery fistula: retrospective comparison of treatment methods
Yang, F.Y.; Criado, E.; Schwartz, J.A.; Keagy, B.A.; Wilcox, B.R.
Southern Medical Journal 81(6): 701-706
1988
ISSN/ISBN: 0038-4348 PMID: 3287639 Document Number: 318129
A fistula between the trachea and the innominate artery, a potentially fatal complication of tracheostomy, can be managed successfully. We have derived several guidelines from our experience with one such case and from a review of the 36 cases reported in the literature over the last decade. Diagnosis must be established before exsanguination occurs. Bronchoscopy and angiography are often nondiagnostic. Control of hemorrhage and a patent airway are the initial goals of treatment. Interruption of the innominate artery is the definitive treatment, with a low rebleeding rate (7%, 1/14 cases) and good long-term survival (64%, 9/14 cases). Maintenance of continuity of the innominate artery is contraindicated, because of a high rebleeding rate (60%, 6/10 cases) and poor long-term survival (10%, 1/10 cases). There is no convincing evidence that interruption of the innominate artery causes significant neurologic or vascular compromise.