Tracheo-brachiocephalic Fistula as a Complication of Tracheostomy Successfully Managed by Endovascular Stenting: a Case Report

Poh Suan Law ¹, Ahmadi Salleh ¹, Naresh Govindarajanthran ²

¹ CARDIOTHORACIC SURGERY DEPARTMENT, HOSPITAL PULAU PINANG, PENANG, Malaysia; ² VASCULAR SURGICAL UNIT, DEPARTMENT OF GENERAL SURGERY, HOSPITAL KUALA LUMPUR, KUALA LUMPUR, Malaysia;

Date, time and location: 2018.05.26 08:30, Exhibition area, 1st Floor. Zone – A

Abstract

Tracheo-brachiocephalic fistula (TBF) is a rare lethal complication of tracheostomy. It usually occurs during 7-14days after tracheostomy. The incidence was quoted less than 1% from available literatures . We describe a case of tracheo-brachiocephalic fistula which successfully managed by endovascular procedure.

Case report

A 14years old boy sustained Diffuse Axonal Injury (DAI) as a consequence of road traffic accident. He was intubated and admitted to Neurosurgical Intensive Care Unit (ICU). Tracheostomy was performed on the 5th day of admission in anticipation of a prolonged ventilation. Ventilation during the first 15 days after tracheostomy was uneventful. However his tracheostomy started to bleed profusely on the 16th day post procedure. Direct laryngoscopy performed by the ENT team revealed a pulsating spurter at the anterior wall of the trachea, just inferior to the tracheostomy stoma, opposite the cuff of the tracheostomy tube. The bleeder was temporarily compressed by inflating the tracheostomy cuff. TBF was confirmed by CT angiography.The TBF was subsequently treated by endovascular stenting.

Conclusion

High clinical suspicious of TBF is required when dealing with bleeding tracheostomy. Untreated TBF almost always fatal. Temporary haemostasis by inflating the tracheostomy cuff can be useful if the bleeder within a compressible area. Multidisciplinary approach in managing TBF cases play a important role to provide excellent care to the patients.