Innominate artery injury during percutaneous tracheostomy; a case report and literature review

Percutaneous tracheostomy is a common procedure that can be performed bedside by intensivists. The widespread adoption of bronchoscopy and ultrasound have also been utilized in the Intensive Care Unit (ICU), leading to the decline of conventional surgical tracheotomy. Percutaneous tracheotomy is thought to have several advantages over conventional tracheotomy. These include a smaller skin incision, less dissection and tissue trauma, and fewer wound complications. Long term complications have also been reported less frequently. One of the possible complications of performing these procedures is innominate artery injury, considered a rare but lethal injury. Injury to the innominate artery occurs in multiple different manners, including blunt, penetrating, or iatrogenic trauma. We report a case of percutaneous tracheostomy complicated by injury to the innominate artery, requiring a conversion to an emergent open surgical tracheostomy. This case report illustrates the potentially fatal complication from performing a percutaneous tracheostomy, highlights the causes and management of innominate artery injury, and provides review of the literature this rare and uncommon complication. • Innominate artery injury during percutaneous tracheostomy is an extremely rare clinical emergency. • Understanding vascular anatomical variations during surgery is crucial for patients who require emergency tracheostomy due to obstructed or injured airways, including patients with maxillofacial trauma. • An open surgical tracheostomy approach should be considered for patients with challenging anatomical variations.