Barış ÇAYNAK, Emine OKLU, Belhhan AKPINAR, Burak ONAN, İsmihan Selen ONAN

Tracheoinnominate artery fistula in a pediatric patient with idiopathic scoliosis

Trakeostomi sonrası trakeoinnominate arter fistül (TİF) oluşumu yaşamı tehdit eden bir komplikasyondur. Uzun süreli ventilasyona bağlı hastalarda trakea ile innominate arterin anatomik ilişkisi önemli bir predispozan faktör olurken, intratorasik arterlerin dispozisyonuna neden olan spinal deformiteler bu nadir komplikasyonun gelişimini kolaylaştırır. Özellikle spinal deformite için düzeltme cerrahisi uygulanan hastalarda, ortopedik cerrahi sonrasında artmış aort disposizyonu, bu potansiyel morbiditeye neden olabilmektedir. Bu yazıda, 14 yaşındaki kız hastada, idiyopatik skolyoz tedavisi için yapılan ortopedik girişim sonrasında gelişen TİF ve acil şartlarda parsiyel sternotomi ile tedavisi sunuldu.

İdiyopatik skolyozlu pediyatrik bir hastada trakeoinnominate arter fistülü

Tracheoinnominate arterial fistula (TIF) is a life-threatening complication which occurs after a tracheostomy. While the anatomical relationship between the trachea and the innominate artery is an important predisposing factor in patients with prolonged ventilation, spinal deformities causing displacement of the intrathoracic arterial structures facilitate development of this rare pathology. Particularly for patients undergoing corrective surgery for spinal deformity, increased aortic displacement following orthopedic surgery may lead to the occurrence of this potential morbidity. In this article, we report a 14-year-old girl who developed TIF after a tracheostomy during the postoperative period of an orthopedic operation for idiopathic scoliosis and underwent an emergent intervention through a partial sternotomy.

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1. Allan JS, Wright CD. Tracheoinnominate fistula: diagnosis and management. Chest Surg Clin N Am 2003;13:331-41.
2. Wood DE, Mathisen DJ. Late complications of tracheotomy. Clin Chest Med 1991;12:597-609.
3. Kapural L, Sprung J, Gluncic I, Kapural M, Andelinovic S, Primorac D, et al. Tracheo-innominate artery fistula after tracheostomy. Anesth Analg 1999;88:777-80.
4. Courcy PA, Rodriguez A, Garrett HE. Operative technique for repair of tracheoinnominate artery fistula. J Vasc Surg 1985;2:332-4.
5. Saito T, Sawabata N, Matsumura T, Nozaki S, Fujimura H, Shinno S. Tracheo-arterial fistula in tracheostomy patients with Duchenne muscular dystrophy. Brain Dev 2006;28:223-7.
6. Donnelly LF. The aortic sling: malpositioned aortic arch surrounding and compressing the trachea in a patient with thoracic deformity. AJR Am J Roentgenol 2001;176:1606-7.
7. Bullmann V, Fallenberg EM, Meier N, Fischbach R, Lerner T, Schulte TL, et al. The position of the aorta relative to the spine before and after anterior instrumentation in right thoracic scoliosis. Spine (Phila Pa 1976) 2006 ;31:1706-13.
8. 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.