KEY POINTS
- Immediate and delayed postoperative bleeding in a patient should
always alert the clinician for the possibility of a TIAF, occurring at
0.7% of tracheostomies
- Rapid patient assessment, with focus on respiratory and hemodynamic
stability is crucial.
- Inflation of the tracheostomy cuff and performing a bed-side flexible
nasendoscopy in the ED upon arrival are warranted to assess for blood
residues in the larynx, followed by prompt CTA or diagnostic IR
angiography in hope to trace the source of the bleeding.
- Surgical repair of TIAF is associated with high mortality rates, and
complications that include cerebral hypoperfusion, graft infection and
re-bleeding.
- Contrary to open surgery, endovascular treatment offers a minimally
invasive approach, rapid hemostasis at the site of injury, easier
recovery due to less morbidity, lower rates of complications including
re-bleeding, and better outcomes.