Tracheo-innominate artery fistula in a laryngectomized patient

Yıl 2008, Cilt: 18 Sayı: 2, 106 - 109, 18.04.2008

Gani Atilla Şengör Ömer Aydın

Öz

Tracheo-innominate artery fistula is a rare but usually fatal complication of tracheostomy or intubation. To our knowledge, this complication has been reported following laryngectomy only in two patients. A 45-yearold woman with hypopharynx carcinoma developed tracheo-innominate artery fistula one month after total laryngopharyngoesophagectomy, as a complication of permanent tracheostomy, induced by the erroneous use of a 12-mm diameter silver tracheostomy cannula. With a median sternotomy, the innominate artery was reconstructed with Gore-Tex vascular graft interposition and separated from the trachea by a pedicled pericardial patch. Unfortunately, the patient sustained intermittent postoperative hemorrhages due to mediastinitis and died on the 15th day. After this tragic result, our attention was focused on both prevention of tracheo-innominate artery fistulas and methods of preventing and dealing with hemorrhages.

Anahtar Kelimeler

Fistula/etiology, laryngectomy, tracheostomy/ adverse effects, vascular fistula/etiology

Larenjektomili bir hastada trakeo-innominat arter fistülü

Öz

Trakeo-innominat arter fistülü, trakeostomi veya entübasyonun nadir fakat ölümcül bir komplikasyo- nudur. Bildiğimiz kadarıyla, bugüne kadar İngilizce literatürde bu komplikasyon larenjektomili hastalarda yalnızca iki olguda bildirilmiştir. Kırk beş yaşında bir kadın hastada hipofarenks kanseri nedeniyle uygu- lanan larengofarenjektomiden bir ay sonra, kalıcı trakeostomiye bağlı, 12 mm çaplı gümüş trakeosto- mi kanülünün neden olduğu trakeo-innominat arter fistülü gelişti. Median sternotomi yaklaşımıyla, inno- minat arter Gore-Tex damar grefti kullanılarak tamir edildi ve pediküllü perikard yaması ile trakeadan ayrıldı. Ameliyat sonrası dönemde mediastinite bağlı kanamalar gelişen hasta 15. günde kaybedildi. Bu trajediye neden olan durum, trakeo-innominat arter fistülü gelişimi ve akut kanamaların önlenmesi ve bu kanamalarla baş edilebilmesi için daha fazla dikkat edilmesi gerektiğini göstermektedir

Anahtar Kelimeler

Fistül/etyoloji, larenjektomi, trakeostomi/yan etki, vasküler fistül/etyoloji

Kaynakça

• Arola MK, Inberg MV, Sotarauta M, Vanttinen E. Tracheo-arterial erosion complicating tracheostomy. Ann Chir Gynaecol 1979;68:9-17.
• Jones JW, Reynolds M, Hewitt RL, Drapanas T. Tracheo-innominate artery erosion: Successful surgi- cal management of a devastating complication. Ann Surg 1976;184:194-204.
• Silen W, Spieker D. Fatal hemorrhage from the innom- inate artery after tracheostomy. Ann Surg 1965;162: 1005-12.
• Schaefer OP, Irwin RS. Tracheoarterial fistula: an unusual complication of tracheostomy. J Intensive Care Med 1995;10:64-75.
• Bloss RS, Ward RE. Survival after tracheoinnominate artery fistula. Am J Surg 1980;139:251-3.
• Hazarika P, Kamath SG, Balakrishnan R, Girish R, Harish K. Tracheo-innominate artery fistula: a rare complication in a laryngectomized patient. J Laryngol Otol 2002;116:562-4.
• Yoshida K, Ohshima H, Iwata K, Murakami F, Tomida Y, Matsuura A, et al. Rupture of the innominate artery following tracheostomy: report of a case. Surg Today. 1998;28:433-4.
• Petrek JA, Bains MS, Spiro RS. Innominate artery fis- tula caused by laryngectomy tube. South Med J 1983; 76:672-4.
• Reed MF, Mathisen DJ. Tracheoesophageal fistula. Chest Surg Clin N Am 2003;13:271-89.
• Nakanishi R, Shimazu A, Mitsudomi T, Masuda T, Osaki T, Onimura S, et al. Successful management of tracheo-innominate artery fistula using interposi- tion of a thymus pedicle flap. J Laryngol Otol 1995; 109:161-2.
• Deguchi J, Furuya T, Tanaka N, Nobori M, Seki Y, Nomura Y, et al. Successful management of tracheo- innominate artery fistula with endovascular stent graft repair. J Vasc Surg 2001;33:1280-2.
• Keceligil HT, Erk MK, Kolbakir F, Yildirim A, Yilman 109