FISTULA between the trachea and a large blood vessel has been a well recognized late complication of tracheostomy. In about 75% of cases, the trachea communicated with the innominate artery; in the remainder with the carotid artery, a thyroid artery, the innominate vein, or the aortic arch.1-10 Silen and Spieker,7 in 1965, described the first such patient to survive the bleeding episode, but unfortunately this patient died two weeks later from bronchopneumonia, presumably related to aspiration.
The purpose of this paper is to record the first long-term survivor after massive hemorrhage from a fistula between the trachea and the innominate artery and to underscore the factors responsible for survival.
Report of a Case
A 14-year-old Negro girl was admitted to the hospital on April 9, 1966, with respiratory difficulty due to progressive muscular weakness of two years' duration. The exact nature of her underlying myoneurologic disease has not