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Chirurgische Versorgung tracheoarterieller Fisteln

Surgical treatment of tracheoarterial fistulas

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Zusammenfassung

Hintergrund

Die tracheoarterielle Fistel (TAF) ist eine seltene, aber lebensbedrohliche Komplikation meist nach der Anlage eines Tracheostoma. Nur durch eine sofortige und gezielte Therapie besteht eine Überlebenschance.

Fragestellung

Chirurgische Therapie der TAF.

Material und Methode

Selektive Literaturrecherche und Fallbeschreibung.

Ergebnisse

Eine TAF führt zu einer akuten Blutungskomplikation mit Verlegung der Atemwege und verläuft unbehandelt in nahezu 100 % der Fälle tödlich. In der Literatur werden unterschiedliche interventionelle und chirurgische Versorgungsmöglichkeiten beschrieben. In der akuten Blutungssituation ist eine schnellstmögliche Kontrolle der Blutung durch sofortige Cuffüberblockung des endotrachealen Tubus bzw. Trachealkanüle und ggf. manuelle äußere Kompression entscheidend. Anschließend sollten eine notfallmäßige chirurgische Versorgung durch Ligatur bzw. Resektion der Fistel und Übernähung des Trachealdefektes erfolgen. Eine ECMO bzw. Herz-Lungen-Maschine kann teilweise notwendig sein.

Schlussfolgerungen

Trotz aller Maßnahmen ist die Letalität bei einer TAF weiterhin hoch. Entscheidend sind eine schnelle Diagnosestellung, die Sicherung der Atemwege und die sofortige Blutungskontrolle.

Abstract

Background

A tracheoarterial fistula (TAF) is an uncommon but life-threatening complication after tracheostomy. Only an immediate and targeted treatment provides a chance to survive.

Objective

Surgical treatment of TAF.

Methods

Selective review of the literature and case description.

Results

A TAF leads to an acute bleeding complication with displacement of the respiratory tract. The mortality rate is nearly 100% without a surgical intervention. In the literature various interventional and surgical treatment procedures are described. Rapid control of bleeding via manual compression and overinflation of the tracheal cuff are the most important steps of treatment. Subsequent emergency surgery with ligation or resection of the TAF and covering of the tracheal lesion should be performed. Extracorporeal membrane oxygenation (ECMO) and a heart-lung machine can sometimes be necessary.

Conclusion

Despite all treatment options the mortality rate of TAF remains high. The critical steps are a quick diagnosis of TAF, securing the airway and immediate bleeding control.

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Authors and Affiliations

  1. Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland

    M. Ried, B. Reger & H.-S. Hofmann

Authors
  1. M. Ried
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  2. B. Reger
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  3. H.-S. Hofmann
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Correspondence to M. Ried.

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Interessenkonflikt

M. Ried, B. Reger und H.-S. Hofmann geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Ried, M., Reger, B. & Hofmann, HS. Chirurgische Versorgung tracheoarterieller Fisteln. Chirurg 90, 731–735 (2019). https://doi.org/10.1007/s00104-019-0978-1

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  • DOI: https://doi.org/10.1007/s00104-019-0978-1

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