Multidisciplinary Team-Assisted Rescue of Innominate Artery Hemorrhage During Tracheotomy for Bilateral Vocal Cord Paralysis Post-Thyroidectomy for Thyroid Cancer: A Case Report and Scoping Literature Review.

[OBJECTIVES] The purpose of this study is to present a case of innominate artery (IA) rupture during tracheotomy, along with its prevention and emergency management. We also conducted a scoping review of the literature on IA hemorrhage during tracheotomy.

[METHODS] Here we describe a case of bilateral vocal cord paralysis after thyroid cancer surgery that developed sudden massive hemorrhage during tracheotomy under local anesthesia. In this study we also compare it to the 12 cases reported in the literature in terms of clinical presentations, reasons of IA injury, immediate hemostatic measures, treatment strategy, postoperative complications, and follow up.

[RESULTS] Our case is a 39-year-old male with a history of thyroid cancer surgery 14 months ago. He presented with worsening hoarseness and exertional dyspnea. He was diagnosed with grade II laryngeal obstruction and bilateral vocal cord paralysis and admitted for surgical airway management. Sudden massive hemorrhage occurred during tracheotomy under local anesthesia. The multidisciplinary team (MDT) was activated, including anesthesiology and vascular surgery. Emergency angiography revealed active bleeding at the IA bifurcation. A covered stent was successfully deployed. The patient subsequently underwent CO laser posterior cordotomy three times to widen the glottic gap. At 32-month follow-up, the patient had no dyspnea, mild hoarseness, and no neurological deficits.

[CONCLUSION] This case highlights the need for preoperative imaging, prompt multidisciplinary intervention, and the utility of endovascular stenting in managing high-risk tracheotomy complications.