Endovascular treatment of tracheo-innominate artery fistula: case report and literature review with pooled cohort analysis

To pool data from published cases of tracheoinnominate artery fistula (TIF) treated with surgical or endovascular techniques along with reporting a case of similar presentation. 261 cases in 137 published case report and case series were identified through a comprehensive systematic literature review. Data regarding patient characteristics, treatment, and follow-up were extracted. A local case of a 14-year-old boy with TIF due to longstanding tracheostomy treated with stent graft placement was added to the data. Comparison of the complication rates between surgical versus endovascular interventions were done with the Chi 2 test. Factors associated with longer survival were assessed by the Cox regression analysis. 33 (12.6%) of the reported cases were treated endovascularly, 137 (52.3%) were treated surgically, and 92 (35.1%) were reported with no definitive treatment. Mean age was 34±22 years, and 61% were males. The mean time interval between tracheotomy placement and bleeding was 1±2.5 years. A lower procedure-related complication (30% versus 50%, P=0.045) and 30-day mortality (9% versus 23%, P=0.008) rates had been reported with percutaneous approaches compared to surgery. No percutaneous procedure was reported prior to year 2000. In multivariate analysis stratified by publication year, a shorter tracheostomy-to-bleeding time (year) was significantly associated with higher hazards of death (HR: 1.22, P=0.017). Type of intervention (percutaneous vs. surgery) was not associated with post-intervention survival (adjusted HR: 0.78, P=0.558). Endovascular stent grafting can have a comparable post-procedural survival and lower complication rates versus open surgical repair in treatment of TIF