Tracheoinnominate Artery Fistula After Tracheostomy: A Systematic Literature Review of Associations With Mortality

Tracheoinnomate artery fistulas (TIF) are a rare but deadly complication of tracheostomy. This study summarizes TIF cases in the literature and seeks to understand associations with mortality. MEDLINE was searched (up May 2021) for studies reporting individual clinical demographic characteristics patients TIFs after Exclusion criteria were: no tracheostomy tube place at time fistula or additional procedures performed site. accordance Preferred Reporting Items Systematic Reviews Meta-Analyses guidelines. A total 122 from 18 case series 46 reports were included. The median age 40.9 years (range: 4-85, interquartile range: 20.9-60.9 years) 53.3% (64 120) male. Trauma leading indication (26.2%, 32 122), followed by head/neck cancer (20.5%, 25 122) structural malformation (19.7%, 24 122). Mortality summarized Table. Overall mortality rate 64.8% (79 15.4% higher females than males (P = .077). There significant difference number days between detection those who survived their vs died (46 23 days, P that initially presented without sentinel bleeding (50% [25 50] 75% [54 72], .005). presence absence frank hemorrhage also showed (59.6% [53 89] 78.8% [26 33], .035). differed whether not cuff overinflated temporary hemostasis during resuscitation (52.2% [35 67] 80% [44 55], < .001). 27 received endovascular management, 2 which ultimately needed open surgery. No found surgical yet both these superior treatment (48.6% [36 74] 89.6% [43 48], Of 49 definitively managed surgery, there 36 innominate resections, 15 tracheal reconstructions, 12 reconstructions. is major concern paired intervention imperative. Investigating bleeds timely fashion intervening upon overinflation may lead improved outcomes.TableMortality characteristicsMortalityP valueDied64.7 (79/122)Sex Male57.8 (37/64).077 Female73.2 (41/56)Age, groups 4-2563.8 (23/36).756 26-5061.4 (27/44) >5069.0 (29/42)Sentinel bleed Present50 (25/50).005 Absent75 (54/72)Hemorrhage Present59.6 (53/89).035 Absent78.8 (26/33)Cuff over inflation Performed52.2 (35/67)<.001 Not performed80 (44/55)Endovascular management Endovascular48.0 (12/25).938 Surgical49.0 (24/49)Definitive Endovascular Surgical48.6 (36/74)<.001 treatment89.6 (43/48)Values represented as percentage count (condition present/total). Open table new tab