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J Thorac Cardiovasc Surg 2007;133:1641-1643
© 2007 The American Association for Thoracic Surgery

Brief Communication

Surgical treatment of tracheoinnominate fistula after stent-graft implantation

Enrico Maria Marone, MDa,*, Gloria Esposito, MDa, Andrea Kahlberg, MDa, Yamume Tshomba, MDa, Chiara Brioschi, MDa, Piero Zannini, MDb, Roberto Chiesa, MDa

a Chair of Vascular Surgery, Department of Thoracic and Cardiovascular Surgery, Scientific Institute H. San Raffaele, Vita-Salute University School of Medicine, Milan, Italy
b Chair of Thoracic Surgery, Department of Thoracic and Cardiovascular Surgery, Scientific Institute H. San Raffaele, Vita-Salute University School of Medicine, Milan, Italy.

Received for publication December 6, 2006; accepted for publication December 12, 2006.

* Address for reprints: Enrico Maria Marone, MD, Chair of Vascular Surgery, Scientific Institute H. San Raffaele, Vita-Salute University School of Medicine, Via Olgettina 60, 20132, Milan, Italy. (Email: marone.enrico@hsr.it).

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


Figure 1
Drs Brioschi, Esposito, Marone, Tshomba, Prof Chiesa, and Dr Kahlberg (left to right)


Protrusion of stent-grafts into adjacent structures is an uncommon but life-threatening complication of endovascular procedures and may result in fistulization. Tracheoinnominate fistulization is a devastating and often fatal condition, requiring prompt diagnosis and appropriate surgical treatment.1Go This report describes a case of a tracheoinnominate fistula as a delayed complication of a posttraumatic pseudoaneurysm endovascular repair.

Clinical Summary

A 21-year-old Asian man with a 5-cm posttraumatic pseudoaneurysm of the innominate artery was treated at the referring hospital by implantation of three covered stents from the origin of the innominate artery to the proximal tract of the right common carotid artery. Postoperative computed tomographic scans showed complete pseudoaneurysm exclusion and right subclavian artery occlusion at the origin, reperfused by the right vertebral artery. The postoperative course was complicated by a tracheal ring laceration (requiring endoscopic toilet and tracheostomy), pulmonary infection, and sepsis. The patient was given antibiotic therapy and discharged in stable conditions.

Two months later, a . . . [Full Text of this Article]




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