Endovascular Repair of a Tracheoinnominate Fistula with a Stent Graft

Massive bleeding from a tracheostomy developed in a 65-year-old woman with stroke after successful conservative management of a minor tracheostomy bleeding episode. Temporary hemostasis was achieved, and angiography showed a tracheoinnominate fistula (TIF), a rare complication of tracheostomy. Open surgery was contraindicated in this patient, so endovascular repair using a stent graft was performed. Permanent hemostasis was obtained, and there were no immediate complications from the procedure. The patient never recovered from her stroke and died 2 weeks later. The endovascular approach may be a feasible alternative to surgical repair of TIF, especially in patients unable to tolerate an open procedure.