Tracheo-innominate artery fistula: reports of two fatal cases and preventive measures
Tracheo-Innominate artery fistulae are complications after tracheostomy, reported in 0.6%-1% of patients within three to four weeks after the procedure and these are fatal in almost all cases. In more than 50% of the cases fatal bleeding is preceded by a warning sign of “sentinel bleed” or herald bleeding from and around tracheostomy tube. Here we are describing two such cases leading to death with no previous warning sign of bleeding. Measures should be taken to prevent formation of trachea-innominate fistula leading to fatal hemorrhage. Ultrasound screening for high arched innominate artery before tracheostomy is best for screening purpose and CECT should be considered for confirmation of anatomic relationship and variations of trachea and innominate artery if high arched innominate is seen.