Post-Tracheostomy Fistula Formation Between the Trachea and Left Common Carotid Artery in a Pediatric Patient with Trisomy 18.

A pediatric patient with trisomy 18 developed a tracheoarterial fistula (TAF) involving the left common carotid artery (LCCA) following emergency tracheostomy.

• The patient was a 3-year-old Japanese boy with trisomy 18.
• Emergency tracheostomy was performed for respiratory failure secondary to pneumonia.
• Massive hemorrhage from the tracheostoma occurred on postoperative day 31.
• The hemorrhage led to the patient's death.

Autopsy revealed that the LCCA had an anomalous origin from the brachiocephalic trunk and coursed medially, forming a fistulous connection with the trachea.

• Normally, the LCCA originates directly from the aortic arch; in this case it arose from the brachiocephalic trunk.
• The anomalous medial course of the LCCA placed it in proximity to the trachea, predisposing fistula formation.
• The anatomical anomaly was identified post-mortem via autopsy.
• This vascular anomaly was not identified prior to the surgical procedure.

The long-term survival of individuals with trisomy 18 has improved, increasing the need for tracheostomy in this population.

• The authors note that improved long-term survival in trisomy 18 has led to increased use of tracheostomy in this population.
• Trisomy 18 is associated with chromosomal abnormalities that may include vascular anomalies.
• This trend increases the clinical relevance of understanding procedure-related risks specific to this population.

The authors recommend preoperative vascular mapping before tracheostomy in patients with chromosomal abnormalities such as trisomy 18.

• The case highlights the clinical importance of preoperative vascular mapping to identify anomalous vessels near the surgical field.
• Vascular anomalies in chromosomal abnormality patients may not be apparent without dedicated imaging.
• Failure to identify the anomalous LCCA course preoperatively contributed to the fatal outcome in this case.