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The Journal of Thoracic and Cardiovascular Surgery, Vol 75, 138-140, Copyright © 1978 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Management of trachea--innominate artery fistula

M Ramesh and AB Gazzaniga

The case histories of three patients with trachea-innominate artery fistula are presented. Low tracheostomy was the etiologic factor producing the fistula in two patients. In both cases, the neck was hyperextended by placing a large roll behind the patient's shoulders and thereby elevating the trachea out of the mediastinum. In one patient a balloon cuff eroded the innominate artery. Management of these patients includes control of hemorrhage by cuff overinflation and/or by endotracheal intubation and packing of the tracheostomy site. The best surgical approach is via a right anterior thoracotomy and a separate neck incision to isolate the blood vessels involved. Median sternotomy should be avoided to prevent mediastinal infection and sternal dehiscence. Carotid stump pressures are a useful guide to determine the efficacy of innominate artery ligation. One patient was saved and is a long-term survivor.


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P. A. Rubio, E. M. Farrell, and B. A. Alvarez
Tracheo-Innominate Artery Fistula: Successful Surgical Repair Using a Portion of the Thymus as an Arterial Wrap
Vascular and Endovascular Surgery, November 1, 1984; 18(6): 395 - 398.
[Abstract] [PDF]


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Copyright © 1978 by The American Association for Thoracic Surgery.