# Innominate Artery Transection via Combined Suprasternal and Intercostal Approach Prevents Tracheoinnominate Artery Fistula

## TL;DR

A new surgical approach prevents a rare but deadly tracheostomy complication in patients with complex anatomy.

## Contribution

A combined suprasternal and intercostal approach for innominate artery transection is proposed for high-risk cases.

## Key findings

- Prophylactic innominate artery transection was successfully performed without limb perfusion issues.
- The combined approach allowed safe surgery in a patient with severe thoracic deformity.
- The patient was discharged without complications, demonstrating the method's effectiveness.

## Abstract

Tracheoinnominate artery fistula is a rare but potentially fatal complication of tracheostomy. We report the case of a 22-year-old male at high risk for tracheoinnominate artery fistula due to severe thoracic deformity. To mitigate the risk, a prophylactic transection of the innominate artery was successfully performed using a combined suprasternal and intercostal approach, thereby avoiding limb perfusion. The patient was discharged without complications. This case highlights the effectiveness of the combined approach for safe innominate artery transection in anatomically challenging cases.