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SIR 2025

Practice Development

Scientific Session

Session: AI, Machine Learning, Simulation, and Imaging 2

Suggestive Radiographic Features for Diagnosis of Tracheo-innominate Fistula

Tuesday, April 1, 2025
3:09 PM – 3:18 PM CT
Location: Music City Center, 202 BC

    Presenting Author(s)

  • Erez Klein, MD

    Interventional Radiology faculty
    Moffitt Cancer Center, United States

    • Author/Co-author(s)

  • ML

    Maxim Leiderman, MD

    Interventional Radiology Faculty
    Rambam health Care Campus, Israel

  • IK

    Igor Kogan, MD

    Interventional Radiology Faculty
    Rambam health Care Campus, Israel

  • AO

    Amos Ofer, MD

    Interventional Radiology Faculty
    Rambam Medical Center, Israel

Purpose: Tracheo-innominate fistula (TIF) is a rare complication in less than 1% of tracheostomy patients. Bleeding from tracheostomy warrants immediate consideration of TIF due to its high mortality rate. This study proposes an algorithm for TIF management based on suggestive radiographic features on CT angiography (CTA).

Materials and Methods:

Retrospective single-center study analyzed medical records of tracheostomy patients presenting with bleeding between 2011 and 2020. Data included patient demographics, bleeding severity, time from tracheostomy to bleeding, diagnostics, interventions, complications, and mortality. A quasi-control group was formed using tracheostomy patients without bleeding who underwent CTA for other reasons. CTA images were retrospectively analyzed for suggestive radiographic features.

Results:

Study identified 100 patients: 33 presenting bleeding around tracheostomy site, concerning for TIF, and 67 serving as the control group. Median time between tracheostomy insertion and bleeding was 16 days. In the study group, 6/33 (18%) showed no anatomical relationship between the innominate artery and trachea on CTA and were not treated. Twelve patients (36%) were treated endovascularly, with three (25%) presenting suggestive radiographic features of TIF on CTA. One additional patient, whose suggestive features were missed at time of scan, deceased the same day. In the control group, 23/67 patients (34.3%) showed no anatomical relationship between innominate artery and trachea.

Conclusion:

Study emphasizes the importance of CTA in suggesting TIF, particularly in stable patients. Suggestive radiographic features on CTA can expedite appropriate patient care, while no anatomical relationship may rule it out. The proposed TIF management algorithm warrants further evaluation with prospective studies to validate its efficacy in improving patient outcomes.