Clinical Note |

Nonsurgical Treatment of Tracheoinnominate Fistula in the Pediatric Population

Arjun S. Joshi, MD; Neil Tanna, MD; Charles A. Elmaraghy, MD; Izi Obokhare, MD; Todd A. Ponsky, MD; Maria T. Pena, MD; Michael C. Slack, MD
Arch Otolaryngol Head Neck Surg. 2007;133(3):294-296. doi:10.1001/archotol.133.3.294.
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The tracheoinnominate fistula (TIF) is a potentially lethal complication traditionally associated with open tracheostomy. Currently, standard treatment involves surgical diversion or occlusion of the innominate artery. Herein, we report the case of a 10-year-old girl with a TIF treated acutely with endovascular stenting; no surgical therapy was undertaken. The patient has been doing well since the procedure, with no associated complications and no further hemorrhaging. Based on the high mortality rate associated with surgical intervention, we believe that endovascular stenting should be considered as the first-line treatment for TIF in the acute setting.

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Figure 1.

Deployment of endovascular stent during angiography.

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Figure 2.

Granulation tissue at area of a tracheoinnominate fistula found at bronchoscopy.

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Figure 3.

Sagittal computed tomographic reconstruction showing tip of tracheostomy tube and endovascular stent.

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