由高位无名动脉引起的气管无名瘘:长期气管切开术后罕见但可能危及生命的并发症

B. Wankhade, A. Abdel Hadi, Z. Alrais, Gopala Kumar Naidu, H. Eid
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引用次数: 0

摘要

气管无名瘘是气管切开术后罕见但可能危及生命的并发症。TIF主要在气管切开术后7-21天内观察到,但也可能在气管切开术后几年出现。TIF的危险因素有袖带压力高、套管尖端位置不正确造成粘膜损伤、气管切口低、颈部过度运动(过伸)、放疗、插管时间延长和高位无名动脉(HRIA)。HRIA也是无名动脉(IA)的一种罕见的解剖变异,而IA在胸锁关节上方分叉。我们报告一例罕见的HRIA患者的TIF,他在经皮气管切开术(PT)后2个月出现气道出血,并通过积极复苏和中线胸骨切开术成功治疗。了解主动脉弓及其主要分支的解剖变异对常规气管切开术的医生来说是必不可少的。所有参与气管切开术管理的卫生保健工作者在处理任何气道出血时都应牢记这一并发症。我们建议在所有PTs前常规使用床边颈部超声检查来定位气管瘘附近的任何异常血管,以防止这种并发症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Tracheoinnominate fistula due to high-riding innominate artery: A rare but potentially life-threatening complication following long-term tracheostomy
Tracheoinnominate fistula (TIF) is a rare but potentially life-threatening complication after tracheostomy. TIF was mostly observed within 7–21 days after tracheostomy but can present even years after tracheostomy. The risk factors for TIF are high cuff pressure, mucosal trauma from malpositioned cannula tip, low tracheal incision, excessive neck movement (hyperextension), radiotherapy, prolonged intubation, and high-riding innominate artery (HRIA). HRIA is also a rare anatomical variation of the innominate artery (IA) whereas IA bifurcates above the sternoclavicular joint. We report a rare case of TIF in a patient with HRIA, who presented with airway bleeding 2 months after percutaneous tracheostomy (PT) and was successfully managed with aggressive resuscitation and midline sternotomy. Knowledge of anatomical variation of the aortic arch and its major branches is essential for the physician who is routinely performing or managing tracheostomy. All the health-care workers involved in the management of tracheostomy should bear this complication in mind while dealing with any airway bleed. We recommend the routine use of bedside neck ultrasonography before all PTs to locate any aberrant vessel within the vicinity of tracheostoma to prevent this complication.
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