Evaluation of Endovascular Intervention for Tracheo-Innominate Artery Fistula: A Systematic Review.

Authors

• Thomas J O'Malley
• Andrew M Jordan
• Kyle W Prochno
• Abhiraj Saxena
• Elizabeth J Maynes
• Brandon Ferrell
• T Sloane Guy
• John W Entwistle
• H Todd Massey
• Rohinton J Morris
• Babak Abai
• Vakhtang Tchantchaleishvili

Publication/Presentation Date

5-1-2021

Abstract

BACKGROUND: While the standard of care for suspected tracheo-innominate artery fistula (TIF) necessitates sternotomy, perioperative mortality remains high. Endovascular interventions have been attempted, but reports have been anecdotal. The aim of this systematic review was to evaluate the outcomes of endovascular management of TIF by pooling the existing evidence.

METHODS: An electronic database search of Ovid MEDLINE, Scopus, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Controlled Trials Register was performed to identify all studies examining endovascular treatment of TIF. Patients greater than 14 years of age who underwent endovascular intervention for TIF were included. 25 studies consisting of 27 patients met the inclusion criteria.

RESULTS: 48.1% (13/27) of patients were male and median age was 39.0 [IQR 16.0, 47.5] years. Tracheostomy was present in 96.3% (26/27) of cases. Median duration from tracheostomy to TIF presentation was 2.2 months [0.5, 42.5]. On presentation, 84.6% (22/26) had tracheal hemorrhage, and 22.8% (6/27) were hemodynamically unstable. 96.3% (26/27) underwent covered stent graft placement while 1 patient (3.8%) had coil embolization. 18.5% (5/27) of patients required repeat endovascular intervention for recurrent bleeding, while 11.1% (3/27) required rescue sternotomy. Median hospital length of stay was 30 days [16.0, 46.5], and overall mortality was 29.6% (8/27) with a median follow-up time of 5 months [1.2, 11.5].

CONCLUSION: While uncommon, endovascular treatment of TIF may be a feasible alternative to sternotomy. The approach may be useful in those who are unable to undergo surgery or are likely to have adhesions from prior chest operations.

Volume

55

Issue

4

First Page

317

Last Page

324

ISSN

1938-9116

Published In/Presented At

O'Malley, T. J., Jordan, A. M., Prochno, K. W., Saxena, A., Maynes, E. J., Ferrell, B., Guy, T. S., Entwistle, J. W., Massey, H. T., Morris, R. J., Abai, B., & Tchantchaleishvili, V. (2021). Evaluation of Endovascular Intervention for Tracheo-Innominate Artery Fistula: A Systematic Review. Vascular and endovascular surgery, 55(4), 317–324. https://doi.org/10.1177/1538574420980625

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

33529132

Department(s)

Administration and Leadership

Document Type

Article