Tracheoinnominate artery fistulas (TIFs) are a rare but deadly complication of tracheostomy. Tracheoinnominate artery fistula cases in the literature were summarized in order to understand mortality associations.
Methods
MEDLINE was searched for studies reporting individual characteristics of patients with TIFs after tracheostomy, excluding cases without tracheostomy or with additional procedures at the tracheostomy site. This study followed PRISMA guidelines.
Results
121 TIF patients from 18 case series and 46 case reports were included. The median age was 40 years, and 52.9% were male. The overall mortality rate was 64.5%. There were differences in mortality between cases that presented initially with vs without sentinel bleeding (odds ratio [OR] .34; CI [confidence interval] .16-.73; P = .006). The mortality rate also differed in whether or not the tracheostomy cuff was over-inflated for temporary hemostasis during resuscitation (OR 3.57 (CI 1.57-8.09); P = .002). Treatment compared to no treatment had lower mortality rates (OR .11 (CI 0.04-.32); P < .001); no differences were found if treatment was endovascular vs open surgical.
Conclusions
Mortality is a major concern after detection of a TIF and resuscitation paired with endovascular or open surgical intervention is imperative. Rapidly investigating sentinel bleeds and intervening upon hemorrhage with temporary cuff over inflation may lead to improved outcomes.
ShahRKLanderLBerryJGNussenbaumBMeratiARobersonDW. Tracheotomy outcomes and complications: A national perspective. Laryngoscope. 2012;122(1):25-29.
2.
O’MalleyTJJordanAMProchnoKWSaxenaAMaynesEJFerrellB, et al.Evaluation of endovascular intervention for tracheo-innominate artery fistula: A systematic review. Vasc Endovascular Surg. 2021;55(4):317-324.
3.
BontempoLJManningSL. Tracheostomy emergencies. Emerg Med Clin North Am. 2019;37(1):109-119.
4.
TaechariyakulTKellerFSJahangiriY. Endovascular treatment of tracheoinnominate artery fistula: Case report and literature review with pooled cohort analysis. Semin Thorac Cardiovasc Surg. 2020;32(1):77-84.
5.
ObaraK. Prevention of tracheo-innominate artery fistula by using an adjustable tracheostomy tube. Cureus. 2021;13(11):e20043. Published 2021 Nov 30.
6.
KimYNChangYSChoKRKimBY. A case of massive subcutaneous emphysema and pneumomediastinum due to dehiscence of stoma after emergent tracheostomy. Ear Nose Throat J. 2022;1455613221129435.
7.
LeeDJYangWPropstEJRosenblattSDHseuAWolterNE. Tracheo-innominate fistula in children: A systematic review of literature. Laryngoscope. 2020;130(1):217-224.
8.
KapuralLSprungJGluncicI, et al.Tracheo-innominate artery fistula after tracheostomy. Anesth Analg. 1999;88(4):777-780.
9.
ScalisePPrunkSRHealyDVottoJ. The incidence of tracheoarterial fistula in patients with chronic tracheostomy tubes: A retrospective study of 544 patients in a long-term care facility. Chest. 2005;128(6):3906-3909.
10.
JesusLESilvaEWGMDBalieiroMFeldmanKDekermacherS. Post-tracheostomy tracheoinnominate fistula: Endovascular treatment. Rev Paul Pediatr. 2021;40:e2020229.
11.
LeschberG.Management of tracheal surgery complications. Thorac Surg Clin. 2014;24(1):107-116.
12.
WangXLXuZGTangPZYuY. Tracheo-innominate artery fistula: Diagnosis and surgical management. Head Neck. 2013;35(12):1713-1718.
13.
YooBLeeBParkJDKwonSKKwakJG. Prevention of tracheo-innominate artery fistula formation as a complication of tracheostomy: Two case reports. Children (Basel). 2022;9(11):1603.
14.
CastaterCHazenBHoppeS, et al.Tracheoinnominate fistula after percutaneous tracheostomy: Successful management with endovascular stenting. Am Surg. 2021;87(11):1839-1841.
15.
BobkaTWSukatoDCKohliNVWorkuBGulkarovIMD’AyalaM. Endovascular management of tracheo-subclavian fistula. Ann Vasc Surg. 2018;53:267.e1-267.e4.
16.
PageMJ, et al.The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. International Journal of Surgery (London, England). 2021;88:105906.
17.
MuradMHSultanSHaffarSBazerbachiF. Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med. 2018;23(2):60-63.
RegerBNeuRHofmannHSRiedM. High mortality in patients with tracheoarterial fistulas: Clinical experience and treatment recommendations. Interact Cardiovasc Thorac Surg. 2018;26(1):12-17.
LinCYLeeKCYangMSLieuFK. Tracheoinnominate artery fistula after percutaneous tracheostomy. J Formos Med Assoc. 2015;114(1):88-89.
22.
ShahDAShahAAShakoorAFatimiSH. An early tracheo-innominate fistula: lessons learnt from a clinical encounter. J Pak Med Assoc. 2015;65(3):343-344.
23.
TroutmanDADoughertyMJSpivackAICalligaroKD. Stent graft placement for a tracheoinnominate artery fistula. Ann Vasc Surg. 2014;28(4):1037.
24.
KomatsuTSowaTFujinagaTHandaNWatanabeH. Tracheo-innominate artery fistula: Two case reports and a clinical review. Ann Thorac Cardiovasc Surg. 2013;19(1):60-62.
25.
NakaiMSatoHSatoMIkomaASandaHNakataK, et al.Tracheo-innominate artery fistula successfully treated by endovascular stent-graft repair. Jpn J Radiol. 2013;31(1):65-70.
26.
ShaukatFIqbalKAkhtarSAmmarA. Tracheo-innominate fistula formation; a rare complication of tracheostomy. J Pak Med Assoc. 2013;63(7):940-943.
27.
SolankiSLGuptaDPatilVPJainM. Tracheo-innominate artery fistula: Report of two fatal cases and preventive measures. Anaesth Intensive Care. 2013;41(6):807-808.
28.
WangXLXuZGTangPZYuY. Tracheo-innominate artery fistula: Diagnosis and surgical management. Head Neck. 2013;35(12):1713-1718.
29.
HisamatsuCOkataYZaimaAYasufukuMMaedaKOkitaY, et al.Innominate artery transection for patients with severe chest deformity: Optimal indication and timing. Pediatr Surg Int. 2012;28(9):877-881.
30.
ShepardPMPhillipsJMTeferaGHartigGK. Tracheoinnominate fistula: Successful management with endovascular stenting. Ear Nose Throat J. 2011;90(7):310-312.
31.
SuzukiRMikamoAKurazumiHHamanoK. Delayed sternal closure after vacuum-assisted closure therapy for tracheo-innominate artery fistula repair. Interact Cardiovasc Thorac Surg. 2011;13(2):229-231.
GuimaraesMSchönholzCPhiferTD'AgostinoH. Endovascular repair of a tracheoinnominate fistula with a stent graft. Vascular. 2008;16(5):287-290.
36.
HamanoKKumadaSHayashiM, et al.Hemorrhage due to tracheoarterial fistula with severe motor and intellectual disability. Pediatr Int. 2008;50(3):337-340.
37.
Jamal-EddineHAyedAKAl-MoosaAAl-SarrafN. Graft repair of tracheo-innominate artery fistula following percutaneous tracheostomy. Interact Cardiovasc Thorac Surg. 2008;7(4):654-655.
38.
RourkeTTassonePClarkeJ. Emergency treatment of haemorrhage from a tracheo-bracheocephalic artery fistula: A life-threatening complication of tracheostomy. Eur J Emerg Med. 2008;15(3):182-184.
39.
GopalakrishnanSMegalamaniSBBeraAViswamV. Tracheo-innominate artery fistula: massive hemorrhage after decannulation. Otolaryngol Head Neck Surg. 2007;136(4 Suppl):S73-S74.
40.
PalchikEBakkenAMSaadNSaadWEDaviesMG. Endovascular treatment of tracheoinnominate artery fistula: A case report. Vasc Endovascular Surg. 2007;41(3):258-261.
41.
SorialEValentinoJGivenCAEndeanEDMinionDJ. The emergency use of endografts in the carotid circulation to control hemorrhage in potentially contaminated fields. J Vasc Surg. 2007;46(4):792-798.
42.
TomoyasuMTanitaTNakajimaTDeguchiHKoizumiJHorieK, et al.Successful repair using innominate vein flap, pericardial flap and thymus pedicle flap for tracheo-innominate artery fistula. Ann Thorac Cardiovasc Surg. 2007;13(2):143-146.
43.
GrantCADempseyGHarrisonJJonesT. Tracheo-innominate artery fistula after percutaneous tracheostomy: Three case reports and a clinical review. Br J Anaesth. 2006;96(1):127-131.
44.
RidleyRWZwischenbergerJB. Tracheoinnominate fistula: Surgical management of an iatrogenic disaster. J Laryngol Otol. 2006;120(8):676-680.
45.
RohJLNaMHKimKH. Treating tracheo-innominate artery fistula with interposition of a pectoralis major myocutaneous flap. Eur Arch Otorhinolaryngol. 2006;263(2):180-182.
46.
SaitoTSawabataNMatsumuraTNozakiSFujimuraHShinnoS. Tracheo-arterial fistula in tracheostomy patients with Duchenne muscular dystrophy. Brain Dev. 2006;28(4):223-227.
47.
LuKTYangSFTingMC. Tracheo-innominate artery fistula after tracheostomy--a case report. Acta Anaesthesiol Taiwan. 2005;43(4):237-241.
48.
ScalisePPrunkSRHealyDVottoJ. The incidence of tracheoarterial fistula in patients with chronic tracheostomy tubes: A retrospective study of 544 patients in a long-term care facility. Chest. 2005;128(6):3906-3909.
49.
WallLPGasparisACriadoE. Endovascular therapy for tracheoinnominate artery fistula: A temporizing measure. Ann Vasc Surg. 2005;19(1):99-102.
50.
GasparriMGNicolosiACAlmassiGH. A novel approach to the management of tracheoinnominate artery fistula. Ann Thorac Surg. 2004;77(4):1424-1426.
51.
NobukiyoSIwatakeHWatanabeSAkaoITomisawaHKoizukaI. A case of relapsing polychondritis involving placement of an expandable metallic stent. Auris Nasus Larynx. 2003;30(Suppl):S141-S144.
52.
SawamuraYTakaseKHiguchiNKikuchiSItoTTabayashiK. Surgical repair for tracheo-innominate artery fistula with a muscle flap. Jpn J Thorac Cardiovasc Surg. 2003;51(11):630-633.
53.
HazarikaPKamathSGBalakrishnanRGirishRHarishK. Tracheo-innominate artery fistula: A rare complication in a laryngectomized patient. J Laryngol Otol. 2002;116(7):562-564.
54.
DeguchiJOFuruyaTTanakaNNoboriMSekiYNomuraY, et al.Successful management of tracheo-innominate artery fistula with endovascular stent graft repair. J Vasc Surg. 2001;33(6):1280-1282.
KapuralLSprungJGluncicIKapuralMAndelinovicSPrimoracD, et al.Tracheo-innominate artery fistula after tracheostomy. Anesth Analg. 1999;88(4):777-780.
57.
YoshidaKOhshimaHIwataKMurakamiFTomidaYMatsuuraA, et al.Rupture of the innominate artery following tracheostomy: Report of a case. Surg Today. 1998;28(4):433-434.
58.
BlackMDShamjiFMToddTR. Trachea-innominate artery fistula and concomitant critical cerebrovascular disease. Ann Thorac Surg. 1996;62(1):286-288.
59.
BillyMLSnowNJHaugRH. Tracheocarotid fistula with life-threatening hemorrhage: Report of case. J Oral Maxillofac Surg. 1994;52(12):1331-1334.
60.
CarsonLStranskyR. A 75-year-old woman with tracheostomy site bleeding. J Emerg Nurs. 1994;20(1):79-80.
61.
YangFYCriadoESchwartzJAKeagyBAWilcoxBR. Trachea-innominate artery fistula: Retrospective comparison of treatment methods. South Med J. 1988;81(6):701-706.
62.
BertelsenSJensenNM. Innominate artery rupture. A fatal complication of tracheostomy. Ann Chir Gynaecol. 1987;76(4):230-233.
63.
HafezACouraudLVellyJFBruneteauA. Late cataclysmic hemorrhage from the innominate artery after tracheostomy. Thorac Cardiovasc Surg. 1984;32(5):315-319.
64.
NelemsJM. Tracheo-innominate artery fistula. Am J Surg. 1981;141(5):526-527.
65.
BartonTKGaedeJT. Recurrent arteriotracheal fistula. South Med J. 1980;73(5):687-688.
CooperJD. Trachea-innominate artery fistula: Successful management of 3 consecutive patients. Ann Thorac Surg. 1977;24(5):439-447.
68.
JonesJWReynoldsMHewittRLDrapanasT. Tracheo-innominate artery erosion: Successful surgical management of a devastating complication. Ann Surg. 1976;184(2):194-204.
69.
MehalicTFFarhatSM. Tracheoarterial fistula: A complication of tracheostomy in patients with brain stem injury. J Trauma. 1972;12(2):140-143.
70.
SilenWSpiekerD. Fatal hemorrhage from the innominate artery after tracheostomy. Trans Pac Coast Otoophthalmol Soc Annu Meet. 1965;46:361-377.
71.
DahillKEDempseyG. Tracheocarotid artery fistula in a patient who had tracheostomy successfully treated with a saphenous vein graft. BMJ Case Rep. 2021;14(3):e237854.
72.
KhanaferAHellsternVMeißnerHHarmeningCSchneiderKHenkesH. Tracheoinnominate fistula: Acute bleeding and hypovolemic shock due to a trachea-innominate artery fistula after long-term tracheostomy, treated with a stent-graft. CVIR Endovasc. 2021;4(1):30.
73.
CastaterCHazenBHoppeS, et al.Tracheoinnominate fistula after percutaneous tracheostomy: Successful management with endovascular stenting. Am Surg. 2021;87(11):1839-1841.
74.
JosephMMBenjaminRPadmanabhanABalDNairS. Successful management of a life-threatening endotracheal bleed with angiographic stenting. Indian J Crit Care Med. 2020;24(3):210-211.
75.
KondajjiADombrowskaAAllemangMSantoscoyT. Emergent management of a tracheoinnominate fistula in the community hospital setting. Cureus. 2020;12(6):e8403.
76.
KondajjiADombrowskaAAllemangMSantoscoyT. Emergent management of a tracheoinnominate fistula in the community hospital setting. Cureus. 2020;12(6):e8403.
77.
NadarVBanikRK. Anesthetic management for emergent repair of tracheoinnominate fistula. Case Rep Anesthesiol. 2020;2020:8865303.
78.
NoguchiSSaitoJKawaguchiJKushikataTHirotaK. Successful respiratory management of a Marshall-Smith syndrome patient with a tracheo-innominate artery fistula. JA Clin Rep. 2020;6(1):37.
79.
ChauhanJCHertzogJHViteriSSlamonNB. Tracheoinnominate artery fistula formation in a child with long-term tracheostomy dependence. J Pediatr Intensive Care. 2019;8(2):96-99.
80.
DonaldsonLRaperR. Successful emergency management of a bleeding tracheoinnominate fistula. BMJ Case Rep. 2019;12(12):e232257.
81.
SafranBGargKScherLShariffSLipsitzE. Repair of isolated innominate artery pathology with a modified endovascular graft. Ann Vasc Surg. 2019;60:475.
82.
VarelliGCioniRCasagliS, et al.Conservative management of trachea-to-innominate artery transfixion with a guidewire during percutaneous tracheostomy: a case report. BMC Anesthesiol. 2019;19(1):224.
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