Preventive Transection of the Innominate Artery

• Published in: The Kitakanto Medical Journal Vol. 73; no. 4; pp. 305 - 308
• Main Authors: Takahashi, Toru, Mohara, Jun, Abe, Tomonobu
• Format: Journal Article
• Language: Japanese
• Published: The Kitakanto Medical Society 01.11.2023
• Subjects: fistula; innominate artery; prevention; trachea; transection
• ISSN: 1343-2826; 1881-1191
• DOI: 10.2974/kmj.73.305

Trachea-innominate artery fistula (TIF) is a critical complication of tracheostomy. We performed preventive transection of the innominate artery (IA) in five patients. Their mean age was 16 years, and each patient underwent tracheostomy with endotracheal cannula for a neuromuscular disorder. The preoperative computed tomography showed tracheal compression and stenosis by the IA, and marked thoracic deformity with scoliosis. Communication of the circle of Willis was also recognized. Arterial lines were placed into the right upper extremities and into the left IA to compare their blood pressures. An anterior collar incision was performed, and the IA, the right common carotid artery (RCCA), and the right subclavian artery (RSCA) were exposed without sternotomy. During temporary clamping of the IA, the mean blood pressure of the right upper extremity was 83 mmHg, and the ratio of right upper extremity pressure to systemic pressure was 0.77. Subsequently, the IA was transected after ligation of the proximal side. The distal stump was closed using running sutures to preserve the carotid subclavian junction. None of the patients required bypass grafting to the IA. Their postoperative courses were uneventful. Preventive transection of IA proved useful in the prevention of TIF.