Tracheal-Innominate Artery Fistula due to Tracheostomy

¹ From the University of Louisville School of Medicine, Louisville

Six cases of massive late bleeding following tracheostomy, diagnosed clinically as tracheal-innominate artery fistula, are presented. This entity is discussed from the point of view of causes, factors such as low placement of the tracheostomy tube below the third tracheal ring, utilization of a mobile ill-fitting tube with an anterior angulation of 90 degrees, use of high-pressure cuffs on metal tubes rather than high-volume low-pressure cuffs on plastic tubes, and hyperextension of the head. Suggested dingnostic measures include fiberoptic bronchoscopy and arteriography if there is enough time. If not, management involves digital compression of the innominate artery against the sternum through the tracheal stoma followed by immediate surgical intervention via median sternotomy, with ligation or resection, or both, of the innominate artery. Prognosis of tracheal-innominate artery fistula is poor, but aggressive management may save many patients.