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Ann Thorac Surg 1996;62:286-288
© 1996 The Society of Thoracic Surgeons

Case Report

Trachea–Innominate Artery Fistula and Concomitant Critical Cerebrovascular Disease

Michael D. Black, MD, Farid M. Shamji, MD, Thomas R. J. Todd, MD

Division of Thoracic Surgery, Ottawa Civic Hospital, University of Ottawa, Ottawa, Ontario, Canada

Accepted for publication February 13, 1996.

To avoid the laborious task of investigating the cerebrovascular circulation in the midst of a trachea–innominate artery fistula, we strongly recommend preoperative cerebrovascular investigations in all patients about to undergo mediastinal tracheostomy. Paramount to this dictum remains the possibility of asymptomatic cerebrovascular disease. Inadequate preoperative cerebrovascular assessment may result in, as described in this report, the possibility of significant postoperative neurologic morbidity or mortality. Angiography should assist the surgeon in deciding which method of cerebral arterial reconstruction is best suited to the individual circumstance. We recommend the avoidance of innominate artery reconstruction even with the interposition of autologous tissues, as the operative field remains grossly infected.




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