Endovascular treatment of tracheo-innominate fistula

Abstract

Introduction: Tracheo-innominate fi stula (TIF) is a rare complication (0.1-1 %) of tracheotomies and endotracheal intubations. It has a high associated morbidity and mortality (90 %), and thus needs early diagnosis and treatment. Case report: we present the case of a 53-year-old man who underwent total laryngectomy with bilateral cervical lymphadenectomy, and who on the second postoperative day presented active bleeding from the tracheostomy tube. The patient underwent an urgent CT angiography that revealed a fi stula between the brachiocephalic trunk (BCT) and the trachea in a position with the tracheostomy tube over the BCT. Expandable balloon covered stent (BeGraftR, Bentley InnoMed, Hechingen, Germany) is deployed from the origin of the BCT to its bifurcation through right humeral approach. The patient is discharged one month after endovascular surgery, presenting a satisfactory postoperative period with the absence of complications. Discussion: TIF is a rare and highly lethal complication that requires emergency management. Typically, TIF were fi rst repaired by open surgery with a survival rate of 25-50 %. Treating TIF in selected cases with the use of endovascular techniques appears to be a safe and eff ective choice with lower associated morbidity and mortality.