From the Guidelines
Tracheo-innominate artery fistula typically occurs as a rare but life-threatening complication of tracheostomy, often due to erosion of the anterior tracheal wall into the adjacent innominate artery, and should be suspected with moderate bleeding from the stomal site or pulsation of the tracheostomy tube. This condition can be fatal if not promptly recognized and managed. The exact timing of when a tracheo-innominate artery fistula occurs is not specified in the provided evidence, but it is known to be a potential complication of tracheostomy 1.
Key Points to Consider
- Tracheostomy bleeding can be immediate, early, or late in presentation and can be minor, moderate, or life-threatening 1.
- Causes of tracheostomy bleeding include traumatic suctioning, granulomata, local infection, bleeding disorders, and rarely, but frequently fatal, hemorrhage from tracheo-arterial fistulae 1.
- A sentinel bleed is reported in around one half of cases, and if suspected, a tracheostomy tube cuff should be hyperinflated, or intubation of the stoma using a cuffed tracheal tube may be required 1.
- Standard resuscitation measures should occur in tandem, and emergency plans made for definitive surgical treatment, which is usually ligation of the innominate artery 1.
Management and Prevention
- Immediate management includes overinflating the cuff for temporary tamponade and urgent surgical intervention 1.
- Prevention involves proper tracheostomy tube placement, maintaining appropriate cuff pressures, minimizing tube movement, and prompt investigation of any bleeding from the tracheostomy site.
- It is essential to be aware of the risk factors and warning signs to promptly identify and manage tracheo-innominate artery fistula, given its potential for fatal outcomes 1.
From the Research
Tracheo-Innominate Artery Fistula Occurrence
- A tracheo-innominate artery fistula is a rare but life-threatening complication of tracheostomy, which can occur at any time after the procedure 2, 3, 4, 5, 6.
- The peak incidence of tracheo-innominate artery fistula is reported to be 3 days to 6 weeks post-tracheostomy procedure 3.
- In some cases, the fistula can occur several months after tracheostomy, as reported in a case where a patient developed a fistula 26 months after tracheostomy 4.
- Tracheo-innominate artery fistula is usually fatal once it bleeds, making immediate treatment crucial for patient survival 2, 3, 5, 6.
Risk Factors and Clinical Presentation
- Tracheostomy is a major risk factor for the development of tracheo-innominate artery fistula 2, 3, 4, 5, 6.
- Peristomal bleed or hemoptysis may be massive and usually fatal if treatment is not instituted immediately 2.
- Sentinel bleeding may be found prior to the development of a tracheo-innominate artery fistula, and an endovascular repair can be a lifesaving temporizing option 6.