DISCUSSION
Any significant bleeding following tracheostomy, either immediate or
delayed is a potential life-threatening complication. Peak incidence and
the risk for bleeding is found during the first 6 weeks after surgery6. Most of delayed postoperative bleedings are the
result of TIAF, and in more than 50% of cases, a sentinel bleeding
occurs. Risk factors associated with an increased risk for TIAF are low
tracheal ring incisions (lower than 3rd ring), which
lead to cannula-induced constant arterial pressure, surgical site
infection and overinflated cuff that can cause pressure necrosis to the
tracheal wall 6.
Surgery to control early and delayed postoperative bleeding in general,
and specifically in cases of TIAF, is still considered the treatment of
choice. Ligation or resection of the innominate artery and repair of the
fistula is usually performed via a median sternotomy approach, with the
use of grafts if needed7. Complications following
surgery include cerebral hypoperfusion that may lead to stroke, graft
infection, high risks of re-bleeding and poor survival rates. Wang
et al , reported a 7% 1-year survival rate following a surgical TIAF
repair 8.