Protection of high-riding aberrant innominate artery during open tracheotomy.

Purpose: Variations of the normal anatomy of the aortic great vessels can lead to severe complications if not recognised pre- or peri-operatively. One such anomaly is a high-riding aberrant innominate artery. Study design: Retrospective review of case series. Materials and methods: We present our experience with seven patients in whom a high aberrant innominate artery was encountered just before or during open tracheotomy. We describe a procedure designed to protect the artery from erosion due to the tracheotomy tube, using an inferiorly based, U-shaped flap from the anterior tracheal wall averted over the innominate artery. Results: None of the patients had any bleeding from the tracheotomy site, during a follow-up period of nine to 46 months. Conclusion: The technique described is simple to perform and prevents any damage to a high aberrant innominate artery, as assessed over a long follow-up period.