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Open Access 01-12-2023 | Amyotrophic Lateral Sclerosis | Case report

Tracheoarterial fistula in a patient with amyotrophic lateral sclerosis successfully managed by overinflation of the tracheostomy tube cuff alone: a case report

Authors: Takashi Hosaka, Shintaro Furuno, Makoto Terada, Yumiko Hamano, Kenichi Komatsu, Katsuichiro Okubo, Yasuaki Koyama, Tetsu Suzuki, Hiroshi Tsuji, Akira Tamaoka, Taro Mizutani

Published in: Journal of Medical Case Reports | Issue 1/2023

Abstract

Background

Tracheoarterial fistula is the most devastating complication after tracheostomy, and its mortality, without definitive treatment, approaches 100%. In general, the combination of bedside emergency management, that is, overinflation of the tracheostomy tube cuff, and definitive treatment such as surgical or endovascular intervention is necessary to prevent the poor outcome. Patients with neuromuscular diseases such as amyotrophic lateral sclerosis are susceptible to tracheoarterial fistula because of long-term mechanical ventilation and muscle weakness.

Case presentation

We describe a case of tracheoarterial fistula in a Japanese 39-year-old patient with amyotrophic lateral sclerosis with long-term ventilator management. The patient was clinically diagnosed with a tracheoarterial fistula because of massive bleeding following sentinel hemorrhage. The massive hemorrhage was controlled by overinflation of the tracheostomy tube cuff alone, without definitive treatment.

Conclusions

This case suggests overinflation of the tracheostomy tube cuff alone plays an important role, semi-permanently, in the management of tracheoarterial fistula, especially in cases where surgical or endovascular intervention is not indicated. Clinicians taking care of patients with tracheostomy undergoing long-term mechanical ventilation should be aware that tracheoarterial fistula might occur following tracheostomy.

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Title: Tracheoarterial fistula in a patient with amyotrophic lateral sclerosis successfully managed by overinflation of the tracheostomy tube cuff alone: a case report
Authors: Takashi Hosaka
Shintaro Furuno
Makoto Terada
Yumiko Hamano
Kenichi Komatsu
Katsuichiro Okubo
Yasuaki Koyama
Tetsu Suzuki
Hiroshi Tsuji
Akira Tamaoka
Taro Mizutani
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Amyotrophic Lateral Sclerosis
Tracheostomy
Published in: Journal of Medical Case Reports / Issue 1/2023
Electronic ISSN: 1752-1947
DOI: https://doi.org/10.1186/s13256-023-03799-z

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Tracheoarterial fistula in a patient with amyotrophic lateral sclerosis successfully managed by overinflation of the tracheostomy tube cuff alone: a case report

Abstract

Background

Case presentation

Conclusions

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