Tracheo-innominate artery fistula after stroke

Area of Science:

• Vascular Surgery
• Critical Care Medicine
• Anesthesiology

Background:

• Tracheo-innominate artery fistula (TIAF) is a rare and life-threatening complication following tracheostomy.
• Massive tracheal hemorrhage, airway obstruction, and hypovolemic shock are critical immediate threats.
• Delayed diagnosis and management significantly increase mortality rates.

Purpose of the Study:

• To report a case of tracheo-innominate artery fistula (TIAF) diagnosed and successfully treated in a patient undergoing rehabilitation.
• To highlight the importance of considering TIAF in patients with tracheostomy experiencing bleeding, even during rehabilitation.

Main Methods:

• A 46-year-old female patient with a history of tracheostomy presented with active bleeding.
• Endotracheal intubation controlled acute hemorrhage; computed tomography and laryngoscopy were initially inconclusive.
• Transfemoral angiography confirmed the TIAF diagnosis, leading to surgical intervention.

Main Results:

• Diagnosis of TIAF was established via transfemoral angiography, revealing an outpouching from the innominate artery to the trachea.
• The patient underwent successful tracheoplasty with a bypass graft for TIAF repair.
• The patient was discharged after 15 weeks of hospitalization and recovery.

Conclusions:

• Tracheo-innominate artery fistula (TIAF) can manifest months after tracheostomy, even during the rehabilitation phase.
• Advanced imaging, particularly angiography, is essential for diagnosing TIAF when initial assessments are negative.
• Prompt surgical management of TIAF is vital for patient survival and successful outcomes.