PMC10017121_01
CT angiography (CTA) at the first bleeding and the second bleeding.
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At the first bleeding, CTA did not show any extravasation (A). The tip of the tracheal cannula is touching the innominate artery (arrow: the contact point of the tip of the tracheal cannula and the innominate artery) (B). Two days later, a second bleeding occurred, and CTA still showed no obvious extravasation (C). The position of the tip of the tracheal cannula was adjusted so as not to contact the innominate artery (arrow: the tip of the tracheal cannula) (D).
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Computed tomography angiography (CTA) showed no active bleeding source, but the tip of the tracheal tube was flushed with the innominate artery (Fig. 1A, B). The position of the tip of the cannula was adjusted so as not to approach the innominate artery (Fig. 1C, D).
Endovascular procedure.
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A 12 Fr long sheath and guide wire were inserted from the right brachial artery, and a pigtail catheter was inserted from the right common femoral artery. Diagnostic imaging showed the entrance of the right brachiocephalic innominate artery and no obvious bleeding source (A). A covered stent made of polytetrafluoroethylene (VIABAHN; 13 mm x 50 mm) was placed so that it did not reach the origin of the common carotid artery and so that it covered the fistula definitively (arrow: distal end of covered stent; arrowhead: proximal end of covered stent) (B, C, D).
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Bleeding disappeared immediately after stent placement (Fig. 2).