BRACHIOCEPHALIC ARTERY EROSION BY A TRACH EOSTOMY CANNULA

We report the case of a 27-year-old severe head trauma patient who dev eloped an erosion of the brachiocephalic artery, 19 days after the ins ertion of a tracheal cannula, Emergency treatment included overinflati on of the tracheostomy cuff and surgery via sternotomy, with occlusion of the tracheostomy and the tracheo-arterial fistula and reimplantati on of the brachiocephalic artery via a vascular prosthesis. This life- threatening complication is due to close anatomic relationships betwee n the trachea and the brachiocephalic artery. In our case, the tip of the cannula eroded the anterior trachea wall resulting in a tracheo-ar terial fistula with massive haemorrhage. Warning symptoms such as puls ations of the cannula and aspiration of blood must be recognised witho ut delay and followed by an adequate pre-established management.