2 Case Reports in Medicine Figure 1: Chest X-ray image shows severe scoliosis. A B C D Figure 2: Chest computed tomography. Computed tomogram before the operation shows extrinsic compression of the trachea by the innominate artery. (A) Superior vena cava; (B) manubrium; (C) innominate artery; (D) trachea. She was transported to our hospital for preventative ligation of the innominate artery and tracheostomy. Brain magnetic resonance CT showed a normal circle of Willis with no occlusion of the internal carotid or innom- inate arteries. 3D CT demonstrated that the innominate artery crossed the trachea from left to right just cranial to the manubrium (Figure 4). We planned prophylactic ligation of the innominate artery to prevent the formation of TIF. The patient was positioned supine under general anes- thesia. A small curvilinear transverse skin incision was made just above the suprasternal notch. The innominate artery was exposed anterior to the trachea (Figure 5). After clamping of the innominate artery, the SpO2, as measured at the right hand and oxygen saturation (rSO2) in both cerebral hemi- spheres, was initially reduced to 70% of baseline readings, but promptly increased to 90%. The innominate artery was transected, and both stumps were closed with continuous Figure 3: Bronchoscopy. Bronchoscopy shows narrowing of the trachea by a pulsatile compression on the anterior tracheal wall (white arrow). Figure 4: 3D CT. Three-dimensional CT shows the innominate artery (white arrow) crossing the trachea from left to right just cranial to the manubrium. absorbable sutures. Thymus tissue was interposed between the proximal and distal stump. After tracheostomy at the 3rd tracheal ring, bronchoscopy revealed a widened tracheal lumen. She was transferred to the intensive care unit for postoperative recovery. The postoperative course was eventful with no neurological complications, and she was discharged on the 6th postoperative day. 3. Discussion TIF is an uncommon complication, aﬀecting fewer than 1% of patients after tracheostomy or tracheoesophageal