Endovascular Treatment for Early and Delayed Life-Threatening Hemorrhage Following Tracheostomy: Our Experience in Four Patients

INTRODUCTION Post tracheostomy hemorrhage is a potentially life-threatening complication that occurs in approximately 1% of cases and requires immediate intervention. Iatrogenic vascular injury to the jugular and carotid vessels and branches of the neck during surgery is usually the cause for major bleedings during the immediate postoperative period, lasting up to 3 days. Delayed bleeding is usually the result of a tracheal erosion by a major artery, leading to pseudoaneurysms or fistulae. In most cases, the innominate artery is involved, resulting in trachea-innominate artery fistula (TIAF), with mortality rates reaching 100%. In some cases, sentinel bleeding, hemoptysis, or pulsation around the cannula may precede. In the past, the only treatment options for acute and delayed bleeding were open surgery to repair, ligate or resect the damaged vessels. Once the bleeding is controlled, repair of the tracheal fistula is indicated. Reported success rates following surgical repairs are low, with high morbidity and mortality of more than 75%. In recent years, an endovascular approach is replacing the need for surgery, with higher survival rates of over 70% and fewer complications. Objectives To describe our experience with endovascular treatments for immediate and delayed post-tracheostomy hemorrhage.