Tracheo-Innominate Artery Fistula: A Systematic Review of Diagnostic and Management Strategies

Tracheo-innominate artery fistula (TIF) is a rare but devastating complication of tracheostomy. A systematic review was performed with the aim of identifying the factors associated with favorable outcomes in cases of TIF post-tracheostomy.

Literature search conducted using PubMed/Medline, Semantic Scholar, OpenAlex, Scopus, and Google Scholar.

The studies describing the development of TIF as a complication of tracheostomy were included. Various demographic and clinical variables, diagnostic and therapeutic approaches, and patient outcomes were analyzed.

The clinical details of 148 cases were extracted from 113 articles meeting the inclusion criteria. The median time between tracheostomy and TIF development was 79.5 days. Sentinel bleeding was present or probably present in 65 (43.92%) cases and was followed by hemorrhage within a week in 41 (27.7%) cases. Radiological modalities were found to have a better diagnostic probability (80.0%) than bronchoscopy (31.48%). Immediate management by cuff overinflation alone was successful in hemorrhage control in 70.59% of instances. Endovascular and open surgical techniques were equally successful in the definitive management of TIF. The interval between tracheostomy and presentation of TIF, and the modality of initial management significantly affect patient survival.

This systematic review highlights the importance of anticipation and assessment of risk factors, ensuring early recognition and instituting prompt intervention in cases of TIF. Further research is recommended to better understand the biomechanics of TIF, improve tracheostomy tube designs, and develop standardized management protocols.