Recognition and Management of Life-Threatening Tracheovascular Fistulae and How to Prevent Them

The occurrence of a fistula between the airway and a major artery can be quickly life threatening due to a combination of major external bleeding and hemorrhagic shock and asphyxiation from flooding of the proximal airways with blood. This complication can occur after cervical tracheostomy open or percutaneous, tracheal resection, cervical exenteration and anterior mediastinal tracheostomy, and laryngectomy. Its diagnosis, which is essentially clinically based, requires a high index of suspicion while its management, which usually involves the division of fistulized blood vessels, can be associated with ischemic strokes. Impairment of arterial perfusion to the right arm and ischemia is another potential complication.