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J Thorac Cardiovasc Surg 2006;131:1415-1416
© 2006 The American Association for Thoracic Surgery

Brief Communication

Fatal fistula between the trachea and the brachiocephalic artery: Late complication of a second-generation, self-expanding metallic tracheal stent

^a Division of General Thoracic and Esophageal Surgery, Department of Cardiothoracic Surgery, Helsinki University Central Hospital, Helsinki, Finland
^b Central Laboratory of Pathology, Helsinki University Central Hospital, Helsinki, Finland.

Received for publication January 11, 2006; accepted for publication February 6, 2006.

^_* Address for reprints: Jarmo A. Salo, MD, PhD, Division of General Thoracic and Esophageal Surgery, Department of Cardiothoracic Surgery, Helsinki University Central Hospital, PO Box 340, Haartmaninkatu 4, FIN-00029 HUS, Helsinki, Finland. (Email: jarmo.salo@hus.fi).

The first 20% of the full text of this article appears below.

Over the past decade, the self-expanding metallic stent (SEMS) has been considered a safe and effective modality for treatment of inoperable malignant and selected benign airway diseases. Cases of life-threatening or massive hemoptysis have, however, occurred after placement of first-generation tracheal SEMSs. We report a case in which a second-generation tracheal SEMS caused ulcer formation and a fistula between the trachea and the brachiocephalic artery 40 months after insertion and discuss the cause, pathogenesis, and clinical features of the massive airway bleeding.

Clinical Summary

A 70-year-old man was treated with local resection and intratracheal brachytherapy because of tracheal adenoid cystic carcinoma. When first seen 16 months later at the Helsinki University Central Hospital, the patient had stridor and dyspnea because of tumor recurrence. Flexible bronchoscopy revealed a 5-cm-long inoperable tumor covered by a 60-mm-long SEMS with a diameter of 18 mm (Ultraflex; Boston Scientific, Galway, Ireland). During the following year, local tumor growth was treated twice with the Nd:YAG laser. Twenty months after SEMS insertion, . . . [Full Text of this Article]

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