Resection of the innominate artery to prevent an impending tracheoinnominate fistula and to permit tracheotomy in a patient with subglottic stenosis and high-riding innominate

Joshua Tokita; Raymond Kung; Kalpaj Parekh; Henry Hoffman

doi:10.1177/0003489414528670

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Resection of the innominate artery to prevent an impending tracheoinnominate fistula and to permit tracheotomy in a patient with subglottic stenosis and high-riding innominate

Journal article

Peer reviewed

Resection of the innominate artery to prevent an impending tracheoinnominate fistula and to permit tracheotomy in a patient with subglottic stenosis and high-riding innominate

Joshua Tokita, Raymond Kung, Kalpaj Parekh and Henry Hoffman

Annals of otology, rhinology & laryngology, Vol.123(9), pp.658-661

09/2014

DOI: 10.1177/0003489414528670

PMID: 24824081

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Abstract

This study aimed to determine the long-term viability of innominate artery resection and tracheotomy for a patient at high risk of developing a tracheoinnominate fistula (TIF) in the setting of subglottic stenosis and a high-riding innominate artery. Chart review with 2-year follow-up. A 45-year-old diabetic man with obstructive sleep apnea and multiple admissions for coma and delirium tremens associated with alcohol abuse developed subglottic stenosis. He was found to have a palpable supraclavicular pulse during preoperative examination for a tracheotomy. Computed tomography examination revealed a high-riding innominate artery at the level of stenosis along with granulation tissue and disruption of the cartilaginous trachea, suggesting a high risk of impending TIF. The patient underwent a sternotomy-approach resection of the innominate artery with closure of the distal stump with a sternohyoid muscle flap. Intraoperatively, a plane of adhesions between the posterior innominate artery and trachea was dissected. The anterior tracheal wall appeared calcified but without evidence of erosion of either the trachea or the artery. Six weeks later, a tracheotomy was performed. Follow-up at 27 months did not identify complications from the innominate artery resection. Resection of the innominate artery is an option for some patients either to address the warning signs of TIF or to permit a tracheotomy to be performed in the presence of a high innominate artery.

Diabetes Complications

Constriction, Pathologic

Humans

Middle Aged

Risk Factors

Male

Sleep Apnea, Obstructive - complications

Treatment Outcome

Glottis - surgery

Brachiocephalic Trunk - surgery

Gastroesophageal Reflux - complications

Tracheal Diseases - prevention & control

Fistula - prevention & control

Alcohol Withdrawal Delirium - complications

Tracheotomy - methods

Details

Title: Subtitle: Resection of the innominate artery to prevent an impending tracheoinnominate fistula and to permit tracheotomy in a patient with subglottic stenosis and high-riding innominate
Creators: Joshua Tokita - Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Raymond Kung - Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Kalpaj Parekh - Department of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Henry Hoffman - Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA henry-hoffman@uiowa.edu
Resource Type: Journal article
Publication Details: Annals of otology, rhinology & laryngology, Vol.123(9), pp.658-661
Publisher: United States
DOI: 10.1177/0003489414528670
PMID: 24824081
ISSN: 0003-4894
eISSN: 1943-572X
Language: English
Date published: 09/2014
Academic Unit: Anatomy and Cell Biology; Surgery; Radiation Oncology; Cardiothoracic Surgery; Otolaryngology
Record Identifier: 9984025354902771

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