Hindawi Publishing Corporation Case Reports in Medicine Volume 2011, Article ID 790746, 4 pages doi:10.1155/2011/790746 Case Report Prophylactic Ligation of the Innominate Artery and Creation of Tracheostomy in a Neurologically Impaired Girl: A Case Report Masayuki Obatake,1 Takayuki Tokunaga,1 Koji Hashizume,2 Kyoko Mochizuki,3 and Takeshi Nagayasu1 1 Division of Pediatric Surgery, Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan 2 Department of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan 3 Division of Pediatric Surgery, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan Correspondence should be addressed to Masayuki Obatake, mobatake@nagasaki-u.ac.jp Received 25 April 2011; Accepted 10 August 2011 Academic Editor: E. N. Myers Copyright © 2011 Masayuki Obatake et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Tracheoinnominate artery ﬁstula is known as a potentially fatal complication for patients who depend on tracheostomy or tracheoesophageal diversion. Since the bleeding from a TIF is often diﬃcult to control, preventative procedures are recommended to avoid this complication. An 11-year-old girl with hypoxic-ischemic encephalopathy and scoliosis developed tracheal stenosis caused by compression from the innominate artery. Respiratory control with intubation through the tracheal stenosis was needed, and the patient was at high risk for developing a TIF. She underwent ligation of the innominate artery at tracheostomy. Subsequent tracheostomy revealed a widened tracheal lumen and no further complications. Prophylactic ligation of the innominate artery and creation of tracheostomy might be considered as a valid option for patients at high risk of developing TIF. 1. Introduction Neurologically impaired children often require tracheostomy or tracheoesophageal diversion for long-term mechanical ventilation. Under these circumstances, numerous compli- cations such as tracheal wall damage, tracheal granulation, and tracheoinnominate ﬁstula (TIF) have been reported [1–3]. TIF is a serious and often fatal complication. Since the survival rate is reported to be less than 30% even with surgical intervention [4, 5], preventive measures are recommended to avoid TIF. We report a case of ligation of the innominate artery before tracheostomy in a patient who had developed tracheal stenosis. 2. Case Report An 11-year-old girl with hypoxic-ischemic encephalopathy had gradually developed scoliosis, and she had experienced several episodes of mild wheezing associated with myotonia. Her SpO2 levels had decreased to 20–30% during episodes of severe myotonia. She was referred to a medical center after the abrupt onset of wheezing and respiratory distress. Chest X-ray revealed scoliosis (Figure 1), and laryngoscopy showed neither supraglottic stenosis nor edema. Chest computed tomography (CT) revealed tracheal stenosis caused by com- pression by the innominate artery (Figure 2). Bronchoscopy demonstrated narrowing of the trachea by external compres- sion of its anterior wall as well as tracheomalacia (Figure 3) involving the middle trachea to the tracheal bifurcation. An uncuﬀed endotracheal tube was inserted distally to the stenosis, and this resulted in a prompt improvement in her respiratory condition. However, she was thought to require long-term tracheal intubation because of the tracheal stenosis and tracheomalacia. Furthermore, she was considered at increased risk of developing tracheal damage and subsequent formation of TIF from tracheal intubation.