Endovascular Treatment for Early and Delayed Life-Threatening Hemorrhage
Following Tracheostomy: Our Experience in Four Patients
Abstract
INTRODUCTION Post tracheostomy hemorrhage is a potentially
life-threatening complication that occurs in approximately 1% of cases
and requires immediate intervention. Iatrogenic vascular injury to the
jugular and carotid vessels and branches of the neck during surgery is
usually the cause for major bleedings during the immediate postoperative
period, lasting up to 3 days. Delayed bleeding is usually the result of
a tracheal erosion by a major artery, leading to pseudoaneurysms or
fistulae. In most cases, the innominate artery is involved, resulting in
trachea-innominate artery fistula (TIAF), with mortality rates reaching
100%. In some cases, sentinel bleeding, hemoptysis, or pulsation around
the cannula may precede. In the past, the only treatment options for
acute and delayed bleeding were open surgery to repair, ligate or resect
the damaged vessels. Once the bleeding is controlled, repair of the
tracheal fistula is indicated. Reported success rates following surgical
repairs are low, with high morbidity and mortality of more than 75%. In
recent years, an endovascular approach is replacing the need for
surgery, with higher survival rates of over 70% and fewer
complications. Objectives To describe our experience with endovascular
treatments for immediate and delayed post-tracheostomy hemorrhage.