Successful Rescue of a Ruptured Tracheoinnominate Fistula with Extracorporeal Membrane Oxygenation, Endovascular Stents, and Debranching Surgical Bypass

Ann Thorac Cardiovasc Surg. 2020 Jun 20;26(3):166-169. doi: 10.5761/atcs.cr.18-00022. Epub 2018 May 18.

Abstract

We reported a case of ruptured tracheoinnominate fistula in a 14-year-old boy with history of repeated sternotomy. Tracheostomy was performed at age 2 years. Slide tracheoplasty was done at age 13 years. He presented to outpatient clinic with episodic hemosputum. Massive blood emanated from stoma during bronchoscopy evaluation. Venous-arterial extracorporeal membrane oxygenation was installed for resuscitation. A contrast-enhanced computed tomography (CT) and angiography confirmed the diagnosis. Immediate control of bleeding was achieved by an endovascular stent graft deployed at innominate artery. Massive hemorrhage recurred on day 7. An aortic arch stent was inserted and all arch vessels debranching via supraclavicular collar excision was performed. A covered stent was used to fenestrate the aortic stent and establish antegrade blood flow to all neck vessels via left common carotid artery. The patient remained stable at 10-month follow-up. Combination of extracorporeal membrane oxygenation, endovascular intervention, and surgical bypass could be effective in treating critical patients.

Keywords: hemoptysis; stent graft; surgical bypass; tracheoinnominate artery fistula; tracheostomy.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Blood Vessel Prosthesis Implantation / instrumentation*
  • Blood Vessel Prosthesis*
  • Brachiocephalic Trunk / diagnostic imaging
  • Brachiocephalic Trunk / surgery*
  • Embolization, Therapeutic
  • Endovascular Procedures / instrumentation*
  • Extracorporeal Membrane Oxygenation*
  • Hemoptysis / etiology
  • Humans
  • Male
  • Respiratory Tract Fistula / diagnostic imaging
  • Respiratory Tract Fistula / etiology
  • Respiratory Tract Fistula / therapy*
  • Stents*
  • Sternotomy / adverse effects
  • Tracheal Diseases / diagnostic imaging
  • Tracheal Diseases / etiology
  • Tracheal Diseases / therapy*
  • Tracheostomy / adverse effects
  • Treatment Outcome
  • Vascular Fistula / diagnostic imaging
  • Vascular Fistula / etiology
  • Vascular Fistula / therapy*