Tracheo-Innominate Artery Fistula

  • Blaine Achen
  • Cairen J. McNamee
  • Tyler Black


In the first part of the 20th century diphtheria was one of the leading causes of tracheal obstruction and likely the main use of tracheostomy was in situations where endotracheal intubation would fail due to a significant tracheal stenosis. Tracheostomy in the early years must have been feared, as it was only in 1909 that Jackson reported a reduction in the mortality from 25% to 1%. It is likely that the early high mortality was as much caused by attempts to deal with the respiratory distress from tracheal obstruction as the surgical aspects of the procedure. Indeed Jackson who introduced the basis for the modern procedure condemned a high tracheostomy (2nd and 3rd tracheal ring) because of a high risk of tracheal stenosis initially attributed to the surgical operation. It was only after the infection rate of diphtheria was reduced that it was accepted that stenosis at the 2nd and 3rd tracheal ring was attributed to diphtheria rather than tracheostomy. Jackson must have performed tracheostomy through lower tracheal rings and thus he may have unknowingly prejudiced patients to tracheoinnominate artery fistula (TIF). The first report of TIF occurred in 1879 when a tracheostomy was performed in a 5 year old child with diphtheria. However over the next 45 years with the increase in the rate of tracheostomy (likely sited low and for inflammation) there were 83 more reported cases of TIF. By 1987 (63 years later) there were only 76 further cases; with only 36 cases reported from 1975 to 1984


Cuff Pressure Tracheostomy Tube Tracheal Stenosis Innominate Artery Tracheal Ring 
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Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

  • Blaine Achen
  • Cairen J. McNamee
  • Tyler Black

There are no affiliations available

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