BACKGROUND Innominate artery aneurysms (IAAs) are relatively rare. Endovascular therapy has been an alternative to open surgery in some IAA cases, but open repair is still necessary in complicated cases. CASE SUMMARY ...BACKGROUND Innominate artery aneurysms (IAAs) are relatively rare. Endovascular therapy has been an alternative to open surgery in some IAA cases, but open repair is still necessary in complicated cases. CASE SUMMARY We report a 35-year-old female who suffered from Takayasu’s arteritis. The patient did not get regular treatment, and IAA and right common carotid artery aneurysm developed, which complicated with occlusion of the left carotid artery, subclavian artery, and the initial part of the left vertebral artery. The patient also had moderate aortic valve insufficiency. With inflammation being controlled well, the patient received the surgery for arterial aneurysms of innominate and right common carotid arteries and aortic valve insufficiency. The shunts for cerebral blood supply were designed to protect the brain and the surgery was conducted successfully under extracorporeal circulation. CONCLUSION The case illustrates that open surgery may be appropriate for some complicated IAAs, and brain protection is important.展开更多
Background: Innominate osteotomy procedures have been widely used as an integral component of combined surgery to treat developmental dysplasia of the hip in children. Autograft concern is further supported by authors...Background: Innominate osteotomy procedures have been widely used as an integral component of combined surgery to treat developmental dysplasia of the hip in children. Autograft concern is further supported by authors who suggest the routine use of internal fixation. Problems such as graft extrusion, rotation and absorption, leading to loss of acetabular correction, were often noted in cases previously treated at our National Hospital for Pediatrics. This retrospective study reviewed the radiographic results of this treatment protocol in 106 hips developmental dislocated hips which met our inclusion criteria. The efficacy of this method to achieve and maintain a well covered and stable hip was the main objective of the study. Methods: This retrospective study reviewed the radiographs of 106 hips presenting with developmental dislocation which were treated by modified Salter’s innomiate osteotomy and using a fibular allograft as the interposition material. Dislocations of the hip were graded using the T?nnis system. Measurement of the acetabular index (AI) was the main variable. The minimum follow up period was 2 years. Possible complications such as loss of acetabular correction, hip redislocation, graft extrusion or resorption, the need for osteotomy internal fixation, delayed or non union, infection or avascular necrosis (AVN) were documented in this series. Results: Between January 2004 and December 2008, 106 surgeries were performed in 95 patients. Sixty-three (86.3%) of the patients were girls and ten (13.7%) were boys, thirteen patients (13.7%) were between twelve and eighteen months old at the time of the operation, the remaining eighty-two (86.3%) patients being between eighteen and thirty-six months old, with the mean age of 22.6 months at the time of surgery. There were eleven (11.6%) patients who had bilateral dislocation. Eighty-four (88.4%) patients were affected unilaterally. The right hip was involved in seventeen (17.9%) and the left hip in sixty-seven (70.5%) cases. T?nnis system Type 3 was in 34 hip (32.1%), and Type 4 was in 72 hip (67.9%). All patients combined open reduction and modified Salter’s innomiate osteotomy, inserting a fibular allograft as the interposition material. Acetabular index was improved, preoperation was 42.95°, and latest follow-up 19.15°, concentrical acetabulum 93.7%. All of the fibulat allografts were completely incorporated mean 14 weeks (range, 12 weeks - 17 weeks) post-surgery. There were five (4.7%) redislocation and subluxation, three AVN (2.8%) and five (4.7%) coxa magna Without graft infections, none of the osteotomies required internal fixation for stability. Final results: Excellent 70 (66.0%), Good 29 (27.4%), Fair 2 (1.9%), Poor 5 (4.7%). Conclusion: Open reduction and modified Salter’s innomiate osteotomy allow interposition material by fibular allografting with a short operative incision, renders excellent osteotomy stability that eliminates the need for internal fixation. Surgical technique are safe and effective for Children between twelve and thirty-six months old.展开更多
Innominate vein aneurysms originating from the mediastinum are very rare. Previous treatments for this condition often required thoracotomy. We report a case of a 43-year-old male who presented a mediastinal mass by c...Innominate vein aneurysms originating from the mediastinum are very rare. Previous treatments for this condition often required thoracotomy. We report a case of a 43-year-old male who presented a mediastinal mass by chest radiography. Contrast-enhanced CT and venography confirmed the diagnosis of left innominate vein aneurysm. The patient underwent endovascular treatment with stent placement and coil embolization of the left innominate vein. The patient remains well 18 months after surgery. The objective of this report is to discuss the diagnosis and endovascular treatment results of innominate vein aneurysm and to review the relevant literature to enhance and expand the pool of knowledge for this abnormality.展开更多
Aim: To investigate the long term results of the patients followed till the skeletal maturity and treated with Salter innominate osteotomy. Patients and Methods: 85 hips of 63 patients whom were operated by the same s...Aim: To investigate the long term results of the patients followed till the skeletal maturity and treated with Salter innominate osteotomy. Patients and Methods: 85 hips of 63 patients whom were operated by the same surgeon between the years 1985 and 1991 were evaluated retrospectively. 34 hips of 25 patients who did not have enough follow-up or did not reach skeletal maturity at their last radiographic control were excluded from the study. So, 51 hips of 38 patients were included into our study. Mean age of the patients at the time of operation was 3 years 2 months (1.5 - 11 years), mean follow-up time was 16 years 6 months (10 - 23 years) and mean age at the last control was 19 years 7 months (15 - 27 years). Results: The overall clinical results were favorable (excellent or good) in 48 hips (94.1%) according to the modified McKay clinical evaluation scale. Avascular necrosis was evaluated with the Kalamchi-McEven classification at the last follow up and 45 hips (88.2%) had no avascular necrosis. The radiographic results were assessed by the Severin classification system and 10 hips (19.6%) were stage 1a;10 hips (19.6%) were stage 1b;and 30 hips (58.8%) were stage 2. Upon the analysis of our radiographic results according to Stulberg classification system, we found out that only 2 (3.9%) of our patients were Stulberg stage 5, whereas 36 cases (70.6%) were Stulberg stage 1 and 2 (spherical congruency). According to Croft’s classification of hips for degenerative changes, 36 (70.6%) patients were stage 0;6 (11.8%) patients were stage 1;5 (9.8%) patients were stage 2 and 4 patients (8.7%) were stage 3. Conclusion: When appropriate soft tissue balance is provided, the complications of Salter Innominate Osteotomy are decreased and thus, it provides an excellent functional and radiological result.展开更多
Aim: Despite the fact that reported low recurrence rates and improvement results, optimal surgical technique for in-guinal hernia repair was not found and recurrence was not eliminated. We used firstly groin innominat...Aim: Despite the fact that reported low recurrence rates and improvement results, optimal surgical technique for in-guinal hernia repair was not found and recurrence was not eliminated. We used firstly groin innominate fascial island flap to reinforce the weak inguinal tissue for the repair. Methods: From the February 2010 to December 2010, 15 patients (13 male and 2 female) with inguinal hernia underwent repair with using island groin innominate fascial flap. The follow-up period ranged from 8 to 12 months (mean, 10 months). Results: Seroma developed in one case. Others had not any complications. Conclusion: Because of our technique avoids from the complications and drawbacks of the prosthetic mesh, autograft and abdominal wall flaps, we think that the groin deep fascial flap can be a good alternative to prosthetic meshes for reconstruction of inguinal hernia repair.展开更多
Purpose:To discuss and share the experience of treatment of traumatic innominate arterial injury.Methods:A retrospective analysis was performed on patients with innominate arterial injuries admitted from January 2016 ...Purpose:To discuss and share the experience of treatment of traumatic innominate arterial injury.Methods:A retrospective analysis was performed on patients with innominate arterial injuries admitted from January 2016 to July 2018 at the department of vascular surgery,Beijing Jishuitan Hospital,China.All the arterial injuries were confirmed by arteriography.Clinical data including mechanism of injury,type of injury,demographics,concomitant injuries,time interval from trauma to blood flow reconstruction,and operation methods were collected.Follow-up program included outpatient visit and duplex-ultrasonography.SPSS version 23.0 was adopted for data analysis.Categorical variables are presented as number and/or frequency and continuous variables as mean±standard deviation.Result:Altogether 7 patients were included and 6(85.7%)were male.The mean age of patients was(29.43±7.98)years,range 19-43 years.Six patients had isolated innominate arterial injuries and the rest 1 combined innominate arterial and vein injuries.The injury causes were road accidents in 3 patients,stab wound in 2,gunshot wound in 1,and crush injury in 1.All the 7 patients presented hemorrhagic shock at admission,which was timely and effectively corrected.No perioperative death or technical complications occurred.Intimal injury(n=2)and partial transaction(n=2)of the innominate artery were treated with covered stents.Two patients with complete transection of artery received vascular reconstruction by artificial grafts.One patient with partial transaction received balloon dilation and open surgical repair(hybrid operation).The mean time interval from trauma to blood flow reconstruction was(4.27±0.18)h,range 4.0e4.5 h;while the operation time was(48.57±19.94)min,range 25e75 min.Cerebral infarction occurred in one patient with brain injury due to anticoagulation contraindication.The average follow-up was(13.29±5.65)months,range 6e24 months.No severe stenosis,occlusion,and thrombosis of covered stents or artificial vessels were found by color Doppler ultrasound.Conclusion:Urgent control of hemorrhage and restoration of blood supply are critical for the treatment of traumatic innominate arterial injury.Endovascular therapy is a feasible and effective method with short operation time and less trauma.展开更多
The management of patients with coexisting diseases who undergo cardiac surgery is a subject to controversial discussions as the operative mortality is thought to be increased by simultaneous procedures. Traditionally...The management of patients with coexisting diseases who undergo cardiac surgery is a subject to controversial discussions as the operative mortality is thought to be increased by simultaneous procedures. Traditionally, the surgical procedures have been staged with the cardiac surgery performed first followed by the visceral operation at a later date. However, especially in cases of malignant disease (e. g. pulmonary or abdominal) the curative treatment is delayed and the additional costs of two settings have to be considered. 1 Although encouraging results have been reported concerning simultaneous pulmonary tumor resection, carotid endarterectomy or abdominal aneurysm repair, 2-5 detailed knowledge concerning further coexisting non-cardiac diseases requiring surgical therapy is still lacking. In some extremely rare cases patients suffer from more than just one coexisting disease of different origins: the current report focuses on a 61-year-old female patient suffering from ischemic heart disease, occlusion of the innominate artery and a retrosternal goiter as an incidental finding. She was treated in a simultaneous procedure with three operations in only one setting. The perioperative features of this special case are reflected in the following course.展开更多
We have reviewed 17 patients (18 hips) who required repeated open reduction for recurrent or persistent dislocation after a previous attempt at zigzag osteotomy combined with fibular allowgraft for developmental dyspl...We have reviewed 17 patients (18 hips) who required repeated open reduction for recurrent or persistent dislocation after a previous attempt at zigzag osteotomy combined with fibular allowgraft for developmental dysplasia of the hip (DDH). The purposes of this study were to examine predictors of redislocation and to evaluate the long-term outcomes after revision surgery. The mean age at primary open reduction was 24 months (13 to 36). The median time to the recognition of failure was 4.6 months. The second reduction was performed at a mean age of 26.3 months (17 to 42) and the mean age at final follow-up was 79.7 months (58 to 105) and the mean time follow-up was 42.4 months (37 to 76). We treated the hips with a new open reduction through an anteromedial approach. A constricted anteromedial capsule was always found as the main factor;all had an intact anteromedial capsule, and there was an inverted transverse ligament in five cases and a very tight psoas tendon in another four cases, eversion of the limbus in six cases, densing anterior capsule in five cases. We perform with the condition that all hips were cleared of scar tissue;five hips had adductor tenotomy;four hips required release of the psoas tendon, five eversion of the limbus. Release of the transverse ligament was required in five cases each. All hips with Kirschner wire through the femoral head into the acetabulum. Three hips required femoral shortening (average of 1.5 cm);a derotation varus osteotomy was performed in two hips from ten and twelve weeks after repeated open reduction. Postoperative results according to modified McKay criteria for clinical: excellent: 3 of 18 hips (16.7%);good: 8 of 18 hips (44.4%);fair: 6 of 18 hips (33.3%);and poor: 1 of 18 hips (5.6%). We suggest that technical failure is usually the cause for redislocation with all that has an intact anteromedial capsule. There was an inverted transverse ligament, tight psoas tendon, eversion of the limbus, and densing anterior capsule. We believe that abnormal femoral version and femoral head dysplasia are also important factors for redislocation too.展开更多
Fatal bleeding in patients with tracheostomy is an uncommon incident, in the order of 0.1% to 1% of cases. It is secondary in 70% of cases to the innominate artery fistula in the tracheal lumen. The fistula is general...Fatal bleeding in patients with tracheostomy is an uncommon incident, in the order of 0.1% to 1% of cases. It is secondary in 70% of cases to the innominate artery fistula in the tracheal lumen. The fistula is generally created after the necrosis of tracheal rings. The incriminated factors are the type of cannula used, the site of tracheal opening below the 3rd tracheal ring, tracheal infections and the proximity of the innominate artery to the tracheal axis. The outcome of this incident is fatal in most cases. We report the case of a 59-year-old patient with a tracheostomy on the 11th day of his admission to intensive care for severe head trauma secondary to a road accident. On the 22nd day of his admission, the occurrence of a cataclysmic and fatal haemorrhage through the tracheostomy tube evoked an arterio-tracheal fistula of the innominate artery.展开更多
文摘BACKGROUND Innominate artery aneurysms (IAAs) are relatively rare. Endovascular therapy has been an alternative to open surgery in some IAA cases, but open repair is still necessary in complicated cases. CASE SUMMARY We report a 35-year-old female who suffered from Takayasu’s arteritis. The patient did not get regular treatment, and IAA and right common carotid artery aneurysm developed, which complicated with occlusion of the left carotid artery, subclavian artery, and the initial part of the left vertebral artery. The patient also had moderate aortic valve insufficiency. With inflammation being controlled well, the patient received the surgery for arterial aneurysms of innominate and right common carotid arteries and aortic valve insufficiency. The shunts for cerebral blood supply were designed to protect the brain and the surgery was conducted successfully under extracorporeal circulation. CONCLUSION The case illustrates that open surgery may be appropriate for some complicated IAAs, and brain protection is important.
文摘Background: Innominate osteotomy procedures have been widely used as an integral component of combined surgery to treat developmental dysplasia of the hip in children. Autograft concern is further supported by authors who suggest the routine use of internal fixation. Problems such as graft extrusion, rotation and absorption, leading to loss of acetabular correction, were often noted in cases previously treated at our National Hospital for Pediatrics. This retrospective study reviewed the radiographic results of this treatment protocol in 106 hips developmental dislocated hips which met our inclusion criteria. The efficacy of this method to achieve and maintain a well covered and stable hip was the main objective of the study. Methods: This retrospective study reviewed the radiographs of 106 hips presenting with developmental dislocation which were treated by modified Salter’s innomiate osteotomy and using a fibular allograft as the interposition material. Dislocations of the hip were graded using the T?nnis system. Measurement of the acetabular index (AI) was the main variable. The minimum follow up period was 2 years. Possible complications such as loss of acetabular correction, hip redislocation, graft extrusion or resorption, the need for osteotomy internal fixation, delayed or non union, infection or avascular necrosis (AVN) were documented in this series. Results: Between January 2004 and December 2008, 106 surgeries were performed in 95 patients. Sixty-three (86.3%) of the patients were girls and ten (13.7%) were boys, thirteen patients (13.7%) were between twelve and eighteen months old at the time of the operation, the remaining eighty-two (86.3%) patients being between eighteen and thirty-six months old, with the mean age of 22.6 months at the time of surgery. There were eleven (11.6%) patients who had bilateral dislocation. Eighty-four (88.4%) patients were affected unilaterally. The right hip was involved in seventeen (17.9%) and the left hip in sixty-seven (70.5%) cases. T?nnis system Type 3 was in 34 hip (32.1%), and Type 4 was in 72 hip (67.9%). All patients combined open reduction and modified Salter’s innomiate osteotomy, inserting a fibular allograft as the interposition material. Acetabular index was improved, preoperation was 42.95°, and latest follow-up 19.15°, concentrical acetabulum 93.7%. All of the fibulat allografts were completely incorporated mean 14 weeks (range, 12 weeks - 17 weeks) post-surgery. There were five (4.7%) redislocation and subluxation, three AVN (2.8%) and five (4.7%) coxa magna Without graft infections, none of the osteotomies required internal fixation for stability. Final results: Excellent 70 (66.0%), Good 29 (27.4%), Fair 2 (1.9%), Poor 5 (4.7%). Conclusion: Open reduction and modified Salter’s innomiate osteotomy allow interposition material by fibular allografting with a short operative incision, renders excellent osteotomy stability that eliminates the need for internal fixation. Surgical technique are safe and effective for Children between twelve and thirty-six months old.
文摘Innominate vein aneurysms originating from the mediastinum are very rare. Previous treatments for this condition often required thoracotomy. We report a case of a 43-year-old male who presented a mediastinal mass by chest radiography. Contrast-enhanced CT and venography confirmed the diagnosis of left innominate vein aneurysm. The patient underwent endovascular treatment with stent placement and coil embolization of the left innominate vein. The patient remains well 18 months after surgery. The objective of this report is to discuss the diagnosis and endovascular treatment results of innominate vein aneurysm and to review the relevant literature to enhance and expand the pool of knowledge for this abnormality.
文摘Aim: To investigate the long term results of the patients followed till the skeletal maturity and treated with Salter innominate osteotomy. Patients and Methods: 85 hips of 63 patients whom were operated by the same surgeon between the years 1985 and 1991 were evaluated retrospectively. 34 hips of 25 patients who did not have enough follow-up or did not reach skeletal maturity at their last radiographic control were excluded from the study. So, 51 hips of 38 patients were included into our study. Mean age of the patients at the time of operation was 3 years 2 months (1.5 - 11 years), mean follow-up time was 16 years 6 months (10 - 23 years) and mean age at the last control was 19 years 7 months (15 - 27 years). Results: The overall clinical results were favorable (excellent or good) in 48 hips (94.1%) according to the modified McKay clinical evaluation scale. Avascular necrosis was evaluated with the Kalamchi-McEven classification at the last follow up and 45 hips (88.2%) had no avascular necrosis. The radiographic results were assessed by the Severin classification system and 10 hips (19.6%) were stage 1a;10 hips (19.6%) were stage 1b;and 30 hips (58.8%) were stage 2. Upon the analysis of our radiographic results according to Stulberg classification system, we found out that only 2 (3.9%) of our patients were Stulberg stage 5, whereas 36 cases (70.6%) were Stulberg stage 1 and 2 (spherical congruency). According to Croft’s classification of hips for degenerative changes, 36 (70.6%) patients were stage 0;6 (11.8%) patients were stage 1;5 (9.8%) patients were stage 2 and 4 patients (8.7%) were stage 3. Conclusion: When appropriate soft tissue balance is provided, the complications of Salter Innominate Osteotomy are decreased and thus, it provides an excellent functional and radiological result.
文摘Aim: Despite the fact that reported low recurrence rates and improvement results, optimal surgical technique for in-guinal hernia repair was not found and recurrence was not eliminated. We used firstly groin innominate fascial island flap to reinforce the weak inguinal tissue for the repair. Methods: From the February 2010 to December 2010, 15 patients (13 male and 2 female) with inguinal hernia underwent repair with using island groin innominate fascial flap. The follow-up period ranged from 8 to 12 months (mean, 10 months). Results: Seroma developed in one case. Others had not any complications. Conclusion: Because of our technique avoids from the complications and drawbacks of the prosthetic mesh, autograft and abdominal wall flaps, we think that the groin deep fascial flap can be a good alternative to prosthetic meshes for reconstruction of inguinal hernia repair.
文摘Purpose:To discuss and share the experience of treatment of traumatic innominate arterial injury.Methods:A retrospective analysis was performed on patients with innominate arterial injuries admitted from January 2016 to July 2018 at the department of vascular surgery,Beijing Jishuitan Hospital,China.All the arterial injuries were confirmed by arteriography.Clinical data including mechanism of injury,type of injury,demographics,concomitant injuries,time interval from trauma to blood flow reconstruction,and operation methods were collected.Follow-up program included outpatient visit and duplex-ultrasonography.SPSS version 23.0 was adopted for data analysis.Categorical variables are presented as number and/or frequency and continuous variables as mean±standard deviation.Result:Altogether 7 patients were included and 6(85.7%)were male.The mean age of patients was(29.43±7.98)years,range 19-43 years.Six patients had isolated innominate arterial injuries and the rest 1 combined innominate arterial and vein injuries.The injury causes were road accidents in 3 patients,stab wound in 2,gunshot wound in 1,and crush injury in 1.All the 7 patients presented hemorrhagic shock at admission,which was timely and effectively corrected.No perioperative death or technical complications occurred.Intimal injury(n=2)and partial transaction(n=2)of the innominate artery were treated with covered stents.Two patients with complete transection of artery received vascular reconstruction by artificial grafts.One patient with partial transaction received balloon dilation and open surgical repair(hybrid operation).The mean time interval from trauma to blood flow reconstruction was(4.27±0.18)h,range 4.0e4.5 h;while the operation time was(48.57±19.94)min,range 25e75 min.Cerebral infarction occurred in one patient with brain injury due to anticoagulation contraindication.The average follow-up was(13.29±5.65)months,range 6e24 months.No severe stenosis,occlusion,and thrombosis of covered stents or artificial vessels were found by color Doppler ultrasound.Conclusion:Urgent control of hemorrhage and restoration of blood supply are critical for the treatment of traumatic innominate arterial injury.Endovascular therapy is a feasible and effective method with short operation time and less trauma.
文摘The management of patients with coexisting diseases who undergo cardiac surgery is a subject to controversial discussions as the operative mortality is thought to be increased by simultaneous procedures. Traditionally, the surgical procedures have been staged with the cardiac surgery performed first followed by the visceral operation at a later date. However, especially in cases of malignant disease (e. g. pulmonary or abdominal) the curative treatment is delayed and the additional costs of two settings have to be considered. 1 Although encouraging results have been reported concerning simultaneous pulmonary tumor resection, carotid endarterectomy or abdominal aneurysm repair, 2-5 detailed knowledge concerning further coexisting non-cardiac diseases requiring surgical therapy is still lacking. In some extremely rare cases patients suffer from more than just one coexisting disease of different origins: the current report focuses on a 61-year-old female patient suffering from ischemic heart disease, occlusion of the innominate artery and a retrosternal goiter as an incidental finding. She was treated in a simultaneous procedure with three operations in only one setting. The perioperative features of this special case are reflected in the following course.
文摘We have reviewed 17 patients (18 hips) who required repeated open reduction for recurrent or persistent dislocation after a previous attempt at zigzag osteotomy combined with fibular allowgraft for developmental dysplasia of the hip (DDH). The purposes of this study were to examine predictors of redislocation and to evaluate the long-term outcomes after revision surgery. The mean age at primary open reduction was 24 months (13 to 36). The median time to the recognition of failure was 4.6 months. The second reduction was performed at a mean age of 26.3 months (17 to 42) and the mean age at final follow-up was 79.7 months (58 to 105) and the mean time follow-up was 42.4 months (37 to 76). We treated the hips with a new open reduction through an anteromedial approach. A constricted anteromedial capsule was always found as the main factor;all had an intact anteromedial capsule, and there was an inverted transverse ligament in five cases and a very tight psoas tendon in another four cases, eversion of the limbus in six cases, densing anterior capsule in five cases. We perform with the condition that all hips were cleared of scar tissue;five hips had adductor tenotomy;four hips required release of the psoas tendon, five eversion of the limbus. Release of the transverse ligament was required in five cases each. All hips with Kirschner wire through the femoral head into the acetabulum. Three hips required femoral shortening (average of 1.5 cm);a derotation varus osteotomy was performed in two hips from ten and twelve weeks after repeated open reduction. Postoperative results according to modified McKay criteria for clinical: excellent: 3 of 18 hips (16.7%);good: 8 of 18 hips (44.4%);fair: 6 of 18 hips (33.3%);and poor: 1 of 18 hips (5.6%). We suggest that technical failure is usually the cause for redislocation with all that has an intact anteromedial capsule. There was an inverted transverse ligament, tight psoas tendon, eversion of the limbus, and densing anterior capsule. We believe that abnormal femoral version and femoral head dysplasia are also important factors for redislocation too.
文摘Fatal bleeding in patients with tracheostomy is an uncommon incident, in the order of 0.1% to 1% of cases. It is secondary in 70% of cases to the innominate artery fistula in the tracheal lumen. The fistula is generally created after the necrosis of tracheal rings. The incriminated factors are the type of cannula used, the site of tracheal opening below the 3rd tracheal ring, tracheal infections and the proximity of the innominate artery to the tracheal axis. The outcome of this incident is fatal in most cases. We report the case of a 59-year-old patient with a tracheostomy on the 11th day of his admission to intensive care for severe head trauma secondary to a road accident. On the 22nd day of his admission, the occurrence of a cataclysmic and fatal haemorrhage through the tracheostomy tube evoked an arterio-tracheal fistula of the innominate artery.
