Endovascular Treatment for Delayed Life Threatening Hemorrhage Following Tracheostomy: Our Experience in Three Patients

Ofir Zavdy, Golda Grinblat, Dan Hebron, Isaac Shochat, Dor Maayan, Waseem Watad, Mickey Dudkiewicz and Itzhak Braverman

Department of Otolaryngology, Rabin Medical Center, Israel
Department of Otolaryngology, Hillel Yaffe Medical Center, Israel
Department of Diagnostic Radiology, Hillel Yaffe Medical Center, Israel
Department of Otolaryngology, Bnai Zion Medical Center, Israel
Hillel Yaffe Medical Center, Israel

^*Correspondance to: Golda Grinblat 

 PDF  Full Text Research Article | Open Access

Abstract:

Post-tracheostomy bleeding is a potentially life-threatening complication. Delayed bleeding is usually the result of a trachea-arterial fistula, most likely an innominate artery (TIAF). Although the risk for TIAF complications in tracheostomy is less than 1%, mortality rates are extremely high. Endovascular interventions are becoming more available worldwide, replacing the need for open surgery. Objective: To describe our experience with endovascular treatments for immediate and delayed post-tracheostomy hemorrhage. Methods: Retrospective case series of three patients, treated with an endovascular approach for delayed life-threatening hemorrhage due to vascular injuries following tracheostomies. Results: Diagnostic imaging studies were performed on all patients and included CTA scans. Emergent interventional angiography was performed via a brachial or femoral approach with the use of stent-graft or balloon grafts. All three patients survived the procedures and were closely monitored in the intensive care unit for a few days before being discharged home. Conclusion: Endovascular treatments offer high success rates and fewer complications, compared to open surgery. It is an important treatment modality for every multidisciplinary team treating post-tracheostomy hemorrhage. Only with proper teamwork, can we be able to rapidly diagnose and treat these patients, and to increase odds for survival.

Keywords:

Bleeding; Trachea-innominate; Fistula; Endovascular; Stenting; Angiography

Cite the Article:

Zavdy O, Grinblat G, Hebron D, Shochat I, Maayan D, Watad W, et al. Endovascular Treatment for Delayed Life Threatening Hemorrhage Following Tracheostomy: Our Experience in Three Patients. Clin Case Rep Int. 2022; 6: 1302.