Tracheoinnominate artery fistula after laryngotracheal separation: prevention and management
Tracheoinnominate artery fistula after laryngotracheal separation: prevention and management
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DOI：
10.1016/j.jpedsurg.2011.11.029
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发表时间：
2012-02-01
影响因子：
2.4
通讯作者：
Kitagawa, Hiroaki
中科院分区：
文献类型：
--
作者：
Sato, Hideaki;Kawase, Hirokazu;Kitagawa, Hiroaki
目的：气管无名动脉瘘（TIF）是喉气管分离（LTS）的常见致命并发症，目前尚无系统的治疗策略来预防或治疗TIF。本研究的目的是建立这样一个战略的基础上，我们的临床经验。材料和方法：从2000年至2010年，14例患者接受LTS。我们回顾这些患者，以制定一种治疗方法来预防或管理TIF.Results：3例患者有大出血，另3例接受预防性治疗前大出血。大出血组中，1例患者因无法控制的出血而窒息死亡，但其他患者通过头臂干分离和/或血管内栓塞抢救。手术时避免了正中胸骨切开术，因为它有很高的纵隔炎风险。在预防性治疗组中，2例患者因严重脊柱侧凸导致纵隔狭窄，CT显示压迫无名动脉，因此进行了预防性头臂干分离。另一个避免了大出血的气管切开管长度可调type.Conclusion：气管无名动脉瘘是一个戏剧性的，往往是致命的并发症。战略方法应旨在预防它，包括评估脊柱畸形的计算机断层扫描，头臂干分离的同时，LTS，并认识到“先驱”或警告轻微出血的重要性。(C)2012 Elsevier Inc. All rights reserved.
Aim: Tracheoinnominate artery fistula (TIF) is an often fatal complication of laryngotracheal separation (LTS) for which there has been no systematic therapeutic strategy for prevention or management of TIF. The aim of this study was to establish such a strategy based on our clinical experience.Materials and Methods: From 2000 to 2010, 14 patients received LTS. We reviewed these patients to develop a therapeutic approach to prevent or manage TIF.Results: Three patients had major bleeding, and another 3 received preventive treatment before major bleeding. In the major bleeding group, 1 patient died of choking from uncontrollable hemorrhage, but the others were rescued by brachiocephalic trunk separation and/or endovascular embolization. At operation, median sternotomy with its high risk of mediastinitis was avoided. In the preventive treatment group, prophylactic brachiocephalic trunk separation was performed for 2 patients because their severe scoliosis narrowed the mediastinum, compressing the innominate artery on computed tomography. Another avoided major bleeding by converting the tracheostomy tube to a length-adjustable type.Conclusion: Tracheoinnominate artery fistula is a dramatic, often lethal complication. The strategic approach should be designed to prevent it and includes evaluation of the spinal deformity on computed tomography, brachiocephalic trunk separation at the same time as LTS, and recognizing the importance of "herald" or warning minor bleeds. (C) 2012 Elsevier Inc. All rights reserved.