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Exsanguinating tracheoinnominate artery fistula repaired with endovascular stent-graft
José E Cohen1, Alex Klimov, Gustavo Rajz
1Department of Neurosurgery, Hadassah Hebrew University Hospital, 91120 Jerusalem, Israel. jcohenns@yahoo.com
Background:
Tracheoinnominate artery fistula is a relatively rare but life-threatening complication of tracheostomy. Peristomal bleed or hemoptysis may be massive and usually fatal if treatment is not instituted immediately.
Case Description:
We report the case of a 40-year-old woman who sustained surgical evacuation of a brainstem cavernoma and developed a massive hemoptysis 13 days after a percutaneous tracheostomy. Because of the patient's poor clinical condition, endovascular repair of the arterial injury was decided. The innominate artery was successfully repaired by means of urgent stent-graft placement.
Conclusions:
We believe that, if technically feasible, stent-graft placement can be a valuable therapeutic alternative for this dramatic condition. Physicians in charge of tracheostomized patients and neurointerventionalists should be familiar with this management strategy.
