INTRODUCTION
Post tracheostomy hemorrhage is a potentially life-threatening
complication that occurs in approximately 1% of cases and requires
immediate intervention 1. 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 2. In most cases, the
innominate artery is involved, resulting in trachea-innominate artery
fistula (TIAF), with mortality rates reaching 100% 3.
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%4. In recent years, an endovascular approach is
replacing the need for surgery, with higher survival rates of over 70%
and fewer complications 5.