气管无名动脉瘘：长期气管切开术后发生气管 - 无名动脉瘘导致急性出血和低血容量性休克，采用覆膜支架治疗。
Tracheoinnominate fistula: acute bleeding and hypovolemic shock due to a trachea-innominate artery fistula after long-term tracheostomy, treated with a stent-graft.
作者信息
Khanafer Ali, Hellstern Victoria, Meißner Helfried, Harmening Christoph, Schneider Klaus, Henkes Hans
机构信息
Neuroradiologische Klinik, Klinikum Stuttgart, Kriegsbergstrasse 60, 70174, Stuttgart, Germany.
Klinik für Gefäßchirurgie, Endovaskuläre Chirurgie und Transplantationschirurgie, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany.
出版信息
CVIR Endovasc. 2021 Mar 19;4(1):30. doi: 10.1186/s42155-021-00216-8.
BACKGROUND
A tracheo-innominate fistula is a rare but life-threatening complication of tracheostomy and has a mortality rate of 100% without therapy. The underlying cause is an acquired fistula between the brachiocephalic trunk and the trachea, induced by a tracheostomy cannula's mechanical impact.
CASE PRESENTATION
A 25-year-old female was admitted with pulsatile bleeding from a tracheostomy. The cause of the bleeding was a tracheo-innominate artery fistula, which was difficult to recognize. Said fistula was treated with implantation of a self-expanding stent-graft. The bleeding stopped immediately after the implantation of the stent-graft. Dual antiplatelet medication with aspirin IV and ticagrelor PO, bridged with a bolus of eptifibatide IV, was started right after the stent deployment.
CONCLUSIONS
Endovascular self-expanding stent-graft implantation is a viable treatment option for tracheo-innominate artery fistulae, especially in hemorrhagic emergencies.
背景
气管无名动脉瘘是气管切开术罕见但危及生命的并发症，未经治疗时死亡率为100%。其根本原因是由气管切开套管的机械冲击导致头臂干与气管之间形成后天性瘘管。
病例报告
一名25岁女性因气管切开处搏动性出血入院。出血原因是气管无名动脉瘘，难以识别。该瘘管用自膨式覆膜支架植入治疗。支架植入后出血立即停止。支架置入后立即开始静脉注射阿司匹林和口服替格瑞洛的双联抗血小板治疗，并静脉推注依替巴肽进行桥接。
结论
血管内自膨式覆膜支架植入是气管无名动脉瘘的可行治疗选择，尤其是在出血性紧急情况下。
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