# Staged Endovascular and Surgical Management of Pediatric Tracheo-Innominate Artery Fistula: A Case Report

## TL;DR

A rare tracheo-innominate artery fistula in a child was successfully managed with a two-step approach combining emergency stenting and later surgery.

## Contribution

This case report demonstrates a staged treatment strategy for pediatric TIF using endovascular stenting followed by surgical repair.

## Key findings

- Emergency endovascular stenting provided immediate hemostasis in a pediatric TIF case.
- Intratracheal graft exposure detected via laryngoscopy necessitated timely surgical removal and tracheal repair.
- A staged approach combining endovascular and surgical methods improved outcomes in a high-risk pediatric patient.

## Abstract

Tracheo-innominate artery fistula (TIF) is rare but potentially fatal, especially in pediatric patients. We present a case treated by emergency endovascular stenting followed by elective open surgery. Stent grafting achieved immediate hemostasis and served as a lifesaving bridge, but its limitations—including risks of infection, rebleeding, and graft mismatch due to somatic growth—made definitive surgery necessary. Laryngoscopic findings revealed intratracheal graft exposure, prompting timely graft removal and tracheal repair. This staged strategy highlights both the value of stenting as bridging therapy and the importance of early multidisciplinary planning in pediatric TIF.