[Successful surgical repair of tracheo-innominate artery fistula in a case of ALS patient with long-term mechanical ventilation].

A 59-year-old man with ALS developed dyspnea and was performed tracheostomy in September 1987. The cuff volume of a tracheostomy tube increased gradually in four years of mechanical ventilation. His chest X-ray in December 1992 showed a marked enlargement of the cuff. In March 1993, massive hemorrhage suddenly occurred through the tracheostomy site. This was controlled by hyperinflation of the cuff. He was diagnosed as tracheo-innominate artery fistula. An emergent operation was done by median sternotomy and right oblique cervical incision. The innominate artery, the subclavian artery and the common carotid artery were severed and occluded with sutures. The tracheal fistula was closed with a suture of monofilament. The postoperative course was satisfactory, however he died of respiratory failure ten months after the surgery.