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Aortic Arch Laceration: A Lethal Complication After Percutaneous Tracheostomy

Percutaneous dilatational tracheostomy (PDT) is not a new technique. However, it was not until Ciaglia introduced a simple technique using a needle, catheter, and guidewire that it became a possible alternative to open surgical tracheotomy. PDT is not performed blindly but with the assistance of fiberoptic endoscopy. However, even with fiberoptic endoscopic control, PDT can give rise to serious complications similar to those encountered with open surgical tracheostomy. We present an uncommon complication of percutaneous tracheostomy, a case of aortic arch laceration. We discuss the anatomy of the pretracheal space and how to avoid such a lethal complication.