-
BMC Medical Imaging Aug 2021Brachiocephalic trunk (BCT) variants may have a clinical impact during surgical procedures, some of which could be fatal. The objective of this study was to classify... (Observational Study)
Observational Study
BACKGROUND
Brachiocephalic trunk (BCT) variants may have a clinical impact during surgical procedures, some of which could be fatal. The objective of this study was to classify height positions of the BCT and report their prevalence in a Mexican population.
METHODS
Patients: A retrospective, descriptive, observational, and cross-sectional was performed using computed tomography angiography (CTA) of adult (> 18 years of age) patients, without gender distinction, of Mexican origin. Measuring techniques were standardized using the suprasternal notch to analyze linear and maximum heights, linear and curved lengths, and the vertebral origin and bifurcation levels of the BCT.
RESULTS
A total of 270 CTA were obtained (66.7% men and 33.3% women). A high position of BCT was present in 64.81% (n 175/270). The mean linear medial height was 0.58 ± 1.91 cm, the maximum height of the free edge was 3.85 ± 2.04 cm, side length of the midline at the maximum height of the free edge was 1.46 ± 2.59, linear length 3.72 ± 0.70, and a curve length 3.99 ± 0.79. The BCT origin was most predominant at the T3 (57.9%) and T4 (27.0%) vertebral levels, with the bifurcation at T2 (57.9%) and T1 (36.2%).
CONCLUSIONS
There is a high prevalence of high position BCT in our population. Patients should be assessed before any procedures in the area, due to the potential risk of complications.
Topics: Adult; Brachiocephalic Trunk; Computed Tomography Angiography; Cross-Sectional Studies; Female; Humans; Male; Mexico; Middle Aged; Neck; Retrospective Studies
PubMed: 34388973
DOI: 10.1186/s12880-021-00645-w -
Acta Medica Academica Apr 2023The current report describes two rare cadaveric findings of a left sided brachiocephalic trunk (BCT) in relation to the trachea, and its high-riding course above the...
OBJECTIVE
The current report describes two rare cadaveric findings of a left sided brachiocephalic trunk (BCT) in relation to the trachea, and its high-riding course above the suprasternal notch (SN).
CASES DESCRIPTION
In two elderly body donors dissected after death, a left-sided BCT was identified with a high-riding course (0.5 and 0.8 cm above the SN). The BCT originated from the aortic arch, in common with the left common carotid artery, more distally than the typical left-side location and crossed in front of the trachea. In the 1st case, the ascending and descending aortae, and the left subclavian artery had aneurysmal dilatation. In both cases, the trachea was displaced to the right side and had a stenosis due to the chronic compression.
CONCLUSION
A high-riding BCT is of paramount clinical importance, as it may complicate tracheotomy, thyroid surgery and mediastinoscopy, leading to fatal complications. BCT injury leads to a massive bleeding during neck dissection (level VI), when the vessel crosses the anterior tracheal wall.
Topics: Humans; Aged; Brachiocephalic Trunk; Aorta, Thoracic; Subclavian Artery; Carotid Artery, Common; Cadaver
PubMed: 37326398
DOI: 10.5644/ama2006-124.402 -
Nan Fang Yi Ke Da Xue Xue Bao = Journal... Jun 2023To observe the anatomical features and relative position of the brachiocephalic trunk and the trachea to provide an anatomical basis for diagnosis and treatment of...
OBJECTIVE
To observe the anatomical features and relative position of the brachiocephalic trunk and the trachea to provide an anatomical basis for diagnosis and treatment of mechanical airway obstruction and for facilitating the performance of tracheotomy.
METHODS
A total of 91 formalin- fixed adult cadavers (70 male and 21 female) were used in this study. The whole length of the larynx and the trachea were separated and exposed from the neck to the chest, followed by separation of the aortic arch and its 3 branches to observe the anatomical position of the brachiocephalic trunk and the trachea.
RESULTS
The brachiocephalic trunk and the trachea did not intersect in 3.30%, partially intersected in 71.43%, and completely intersected in 25.27% of the 91 cadaveric specimens. The male specimens all showed greater outer diameter of the aortic arch, the brachiocephalic trunk and the trachea with a greater length of the trachea than the female specimens ( < 0.05), while the distances from the aortic arch to the brachiocephalic trunk or the cricoid cartilage did not differ significantly between them ( > 0.05). The number of the tracheal cartilage rings above the brachiocephalic trunk ranged from 3 to 10, and the mean number did not differ significantly between the male and female specimens ( > 0.05).
CONCLUSION
The brachiocephalic trunk has complex anatomical relationship with the trachea, and caution should be taken to avoid injuries of the brachiocephalic trunk and the aortic arch in the diagnosis and treatment of mechanical respiratory obstruction and during tracheotomy.
Topics: Adult; Female; Male; Humans; Trachea; Brachiocephalic Trunk; Larynx; Cadaver; Formaldehyde
PubMed: 37439169
DOI: 10.12122/j.issn.1673-4254.2023.06.12 -
Veterinary Sciences Apr 2017Coronary artery anomalies represent a disease spectrum from incidental to life-threatening. Anomalies of coronary artery origin and course are well-recognized in human... (Review)
Review
Coronary artery anomalies represent a disease spectrum from incidental to life-threatening. Anomalies of coronary artery origin and course are well-recognized in human medicine, but have received limited attention in veterinary medicine. Coronary artery anomalies are best described in the dog, hamster, and cow though reports also exist in the horse and pig. The most well-known anomaly in veterinary medicine is anomalous coronary artery origin with a prepulmonary course in dogs, which limits treatment of pulmonary valve stenosis. A categorization scheme for coronary artery anomalies in animals is suggested, dividing these anomalies into those of major or minor clinical significance. A review of coronary artery development, anatomy, and reported anomalies in domesticated species is provided and four novel canine examples of anomalous coronary artery origin are described: an English bulldog with single left coronary ostium and a retroaortic right coronary artery; an English bulldog with single right coronary ostium and transseptal left coronary artery; an English bulldog with single right coronary ostium and absent left coronary artery with a prepulmonary paraconal interventricular branch and an interarterial circumflex branch; and a mixed-breed dog with tetralogy of Fallot and anomalous origin of all coronary branches from the brachiocephalic trunk. Coronary arterial fistulae are also described including a coronary cameral fistula in a llama cria and an English bulldog with coronary artery aneurysm and anomalous shunting vessels from the right coronary artery to the pulmonary trunk. These examples are provided with the intent to raise awareness and improve understanding of such defects.
PubMed: 29056679
DOI: 10.3390/vetsci4020020 -
Jornal Vascular Brasileiro 2016Ehlers-Danlos syndrome is a genetic disease that results in abnormalities of collagen synthesis, causing extremely fragile connective tissue. This fragility predisposes...
Ehlers-Danlos syndrome is a genetic disease that results in abnormalities of collagen synthesis, causing extremely fragile connective tissue. This fragility predisposes patients to a series of vascular disorders, such as dissections, aneurysms and pseudoaneurysms. The authors describe the case of a 19-year-old patient with an aneurysm of the brachiocephalic trunk who was treated endovascularly by placement of covered stents. The case progressed with complications at the puncture site, which was also treated on an emergency basis, using endovascular techniques with a covered stent.
PubMed: 29930596
DOI: 10.1590/1677-5449.001016 -
The Journal of Thoracic and... Feb 2016
Topics: Aorta, Thoracic; Brachiocephalic Trunk; Decompression, Surgical; Diverticulum; Humans; Male; Replantation; Tracheal Stenosis; Vascular Malformations; Vascular Surgical Procedures
PubMed: 26614416
DOI: 10.1016/j.jtcvs.2015.10.084 -
Annals of Surgery Nov 1982From 1965 through 1980, 51 men and 49 women (mean age: 55 years) underwent transthoracic or extrathoracic revascularization of the innominate, common carotid,...
From 1965 through 1980, 51 men and 49 women (mean age: 55 years) underwent transthoracic or extrathoracic revascularization of the innominate, common carotid, subclavian, or vertebral arteries. Preoperative symptoms were limited to the vertebrobasilar syndrome in 29 patients, to hemispheric neurologic or monocular visual events in 19, and to upper extremity ischemia in 13. Multiple symptoms were present in 27 other patients, and 12 patients were asymptomatic before operation. Median sternotomy was performed for correction of innominate, common carotid, or subclavian lesions in 34 patients, including six simultaneous brachiocephalic and cardiac procedures, with five operative deaths (14.7%). Extrathoracic reconstruction, such as carotosubclavian and axilloaxillary bypass or vertebral endarterectomy and reimplantation, was employed in 66 patients, with two operative strokes but no mortality (p less than .01). Late results were obtained from two to 189 months after operation (mean: 52 months). Considering their original symptoms, 82 patients have been classified as asymptomatic or improved, nine as unchanged, and nine others, including those who had operative complications, as worse. Twelve patients have eventually sustained either transient cerebral ischemia (six) or strokes (six), most of which were unrelated to eight documented late operative failures. In addition to 20 patients who required combined brachiocephalic and carotid bifurcation reconstruction, 27 additional carotid endarterectomies have at some time been necessary for patients having extensive cerebrovascular disease. Twenty patients have died during the follow-up interval, including eight with myocardial infarctions, but only one with a fatal stroke.
Topics: Adult; Aged; Angiography; Arm; Arteries; Brachiocephalic Trunk; Carotid Arteries; Endarterectomy; Female; Follow-Up Studies; Head; Humans; Male; Middle Aged; Postoperative Complications; Subclavian Artery; Vertebral Artery
PubMed: 6751246
DOI: 10.1097/00000658-198211000-00006 -
Irish Journal of Medical Science Aug 2023Many anatomical variations of the branching pattern of the aortic arch have been documented in the literature. These find their origin in alterations to the... (Review)
Review
BACKGROUND
Many anatomical variations of the branching pattern of the aortic arch have been documented in the literature. These find their origin in alterations to the embryological development of the arch and have significant implications for surgical and radiological interventions.
METHODS
Embase and Medline database searches were carried out in June 2021 and identified 1197 articles, of which 24 were considered eligible.
RESULTS
Twenty-eight variations were found. The prevalence of the six main variations found is as follows: normal configuration (61.2-92.59%); bovine arch type 1 (4.95-31.2%); bovine arch type 2 (0.04-24%); origin of left vertebral artery (0.17-15.3%); aberrant right subclavian artery (0.08-3.33%); thyroid ima artery (0.08-2%). Concomitant variations present in conjunction with these variations are also documented, as were other variations which could not be classified into these six groups.
CONCLUSIONS
Anatomical variations in the branching pattern of the aortic arch are present in over one-third of individuals in some populations. These are important pre- and intra-operatively during thoracic, neck and thyroid surgery. A greater effort should be employed to construct an official classification to facilitate greater understanding among clinicians.
Topics: Humans; Aorta, Thoracic; Subclavian Artery; Cardiovascular Abnormalities; Prevalence
PubMed: 36272028
DOI: 10.1007/s11845-022-03196-3