Tracheo-innominate artery fistula after percutaneous tracheostomy: three case reports and a clinical review
Tracheo-innominate artery fistula after percutaneous tracheostomy: three case reports and a clinical review
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DOI：
10.1093/bja/aei282
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发表时间：
2006-01-01
影响因子：
9.8
通讯作者：
Jones, T
中科院分区：
文献类型：
--
作者：
Grant, CA;Dempsey, G;Jones, T
气管无名动脉瘘（TIF）是气管切开术后罕见但危及生命的并发症。据报道，气管切开术后的发生率为0.1-1%，在手术后7-14天达到高峰。除非立即进行治疗，否则通常是致命的。最初的病例报告是由于气管切开术引起的。我们报告三例经组织病理学证实的经皮扩张性气管切开术（PDT）后因TIF死亡的病例。PDT的使用导致气管切开术由来自不同背景的专家进行，这种并发症的发生率可能正在增加。高袖带压力导致的压力性坏死、套管尖端位置不正确造成的粘膜损伤、气管低切口、放疗和长时间插管都与TIF的形成有关。气管切开术后3天至6周发生的大出血是TIF的结果，除非证明并非如此。我们提出了一个简单的算法来处理这种情况。所概述的操作将通过直接填塞效果控制80%以上患者的出血。手术止血是通过近端清除无名动脉，然后横切并关闭管腔。神经系统后遗症很少。死后诊断TIF可能是困难的，但具体的病理要求应评估无名动脉异常。
Tracheo-innominate artery fistula (TIF) is an uncommon yet life threatening complication after a tracheostomy. Rates of 0.1-1% after surgical tracheostomy have been reported, with a peak incidence at 7-14 days post procedure. It is usually fatal unless treatment is instituted immediately. Initial case reports of TIF resulted from surgically performed tracheostomies. We present three fatalities attributable to TIF, confirmed by histopathology, after percutaneous dilatational tracheostomy (PDT). The use of PDT has resulted in tracheostomies being performed by specialists from different backgrounds and the incidence of this complication may be increasing. Pressure necrosis from high cuff pressure, mucosal trauma from malpositioned cannula tip, low tracheal incision, radiotherapy and prolonged intubation are all implicated in TIF formation. Massive haemorrhage occurring 3 days to 6 weeks after tracheostomy is a result of TIF until proven otherwise. We present a simple algorithm for management of this situation. The manoeuvres outlined will control bleeding in more than 80% of patients by a direct tamponade effect. Surgical stasis is obtained by debriding the innominate artery proximally, then transecting and closing the lumen. Neurological sequelae are few. Post-mortem diagnosis of TIF may be difficult, but specific pathology request should be made to assess innominate artery abnormalities.