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European Journal of Cardio-thoracic... Apr 2020Aortic dissections after deceleration traumas are mainly located in the region of the proximal descending thoracic aorta. Less common are brachiocephalic trunk ruptures,...
Aortic dissections after deceleration traumas are mainly located in the region of the proximal descending thoracic aorta. Less common are brachiocephalic trunk ruptures, which are not automatically amenable to an endovascular treatment. We present a poly-traumatized patient with an intimal tear at the origin of the brachiocephalic tunk with intramural haematoma extension to the ascending aorta. In addition, the left common carotid artery originated from the proximal brachiocephalic trunk, forming a 'bovine arch'. Aortic arch and supra-aortic arteries were successfully replaced. The case demonstrates the importance of an individualized treatment in complex intrathoracic vascular injuries in poly-traumatized patients, including a careful risk assessment.
Topics: Aortic Dissection; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Brachiocephalic Trunk; Dissection; Humans; Stents; Treatment Outcome
PubMed: 31504372
DOI: 10.1093/ejcts/ezz236 -
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 -
Archiwum Medycyny Sadowej I Kryminologii 2016The paper presents a rare case of injury to the brachiocephalic trunk wall during percutaneous tracheotomy. The complication developed in a post-cardiac arrest patient...
The paper presents a rare case of injury to the brachiocephalic trunk wall during percutaneous tracheotomy. The complication developed in a post-cardiac arrest patient in a poor general condition. During hospitalization in the Intensive Care Unit, the patient suffered a haemorrhage directly from and around the endotracheal tube. After another episode of massive bleeding the patient died. The autopsy found that the source of the bleeding was injury to the brachiocephalic trunk.
Topics: Aged; Brachiocephalic Trunk; Critical Illness; Fatal Outcome; Humans; Intubation, Intratracheal; Male; Postoperative Hemorrhage; Respiration, Artificial; Tracheotomy
PubMed: 28677380
DOI: 10.5114/amsik.2016.68100 -
Pediatric Cardiology Dec 2018The purpose of the study was to explore the prognosis, as well as antenatal ultrasonic features of isolated left subclavian artery (ILSCA) and isolated left... (Review)
Review
The purpose of the study was to explore the prognosis, as well as antenatal ultrasonic features of isolated left subclavian artery (ILSCA) and isolated left brachiocephalic trunk (ILBCT) malformations, in order to improve prognosis and provide guidance for prenatal diagnosis. The origin and routing of cephalic and cervical vessels were observed in patients diagnosed with right aortic arch or right arterial duct arch in our hospital from March 2015 to March 2017, and the spectrum features related to ILSCA and ILBCT were analyzed. Fetuses diagnosed as ILSCA, or, and ILBCT were followed up for 3 months after birth. At the same time, a literature review was carried out for ILBCT and ILSCA in Pubmed. In our study, two cases with ILSCA and ILBCT were both diagnosed prenatally. They are not accompanied by other congenital malformations or chromosome abnormalities. No abnormality was found during postnatal follow-up except that left radial pulsation was weakened and blood pressure of the left upper limb decreased in baby with ILSCA. In baby with ILBCT, in addition to these abnormal changes, the left common carotid artery pulse disappearance too. In pubmed, three of 12 ILSCA or ILBCT did not have other congenital malformation or chromosome abnormalities. They were not diagnosed until the age of 3, 10, and 47 because of school exams or atypical symptoms, such as headaches, chest pain. Symptom of ILBCT or ILSCA without other abnormality is silent, and therefore they cannot be diagnosed timely after birth prenatal diagnosis is necessary for they can be treated in time.
Topics: Aorta, Thoracic; Aortic Arch Syndromes; Brachiocephalic Trunk; Female; Humans; Male; Pregnancy; Prognosis; Subclavian Artery; Ultrasonography, Prenatal
PubMed: 30167747
DOI: 10.1007/s00246-018-1945-1 -
Medicina Intensiva May 2013
Topics: Aged, 80 and over; Brachiocephalic Trunk; Female; Humans; Radiography; Trachea
PubMed: 22305200
DOI: 10.1016/j.medin.2011.09.009 -
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 -
Journal of Cardiac Surgery Jul 2013The surgical approach to a large pseudoaneurysm of the brachiocephalic trunk may be hazardous because of its high risk of rupture. An adequate vascular control is vital...
The surgical approach to a large pseudoaneurysm of the brachiocephalic trunk may be hazardous because of its high risk of rupture. An adequate vascular control is vital before attempting to manage the pseudoaneurysm. We describe a surgical technique using deep hypothermic circulatory arrest to repair a giant pseudoaneurysm of the brachiocephalic trunk with impending rupture and severe respiratory distress and superior vena cava compression secondary to multisystem trauma.
Topics: Aneurysm, False; Brachiocephalic Trunk; Circulatory Arrest, Deep Hypothermia Induced; Humans; Male; Middle Aged; Multiple Trauma; Respiratory Distress Syndrome; Severity of Illness Index; Treatment Outcome; Vascular Surgical Procedures; Vena Cava, Superior
PubMed: 23656189
DOI: 10.1111/jocs.12117 -
Clinical Anatomy (New York, N.Y.) Jan 2010Respiratory compromise due to tracheal compression by the brachiocephalic trunk (BT), a condition first labeled as Innominate Artery Compression Syndrome (IACS), has... (Review)
Review
Anatomical variation in the position of the brachiocephalic trunk (innominate artery) with respect to the trachea: a computed tomography-based study and literature review of Innominate Artery Compression Syndrome.
Respiratory compromise due to tracheal compression by the brachiocephalic trunk (BT), a condition first labeled as Innominate Artery Compression Syndrome (IACS), has been controversially attributed to an anomalous origin of this vessel to the left of, and hence crossing, the trachea. The aim of this study was to establish the normal relationship between the BT and trachea in infants, children, and young adults without obstructive respiratory symptoms. One hundred and eighty-one computed tomography (CT) examinations of the thorax, in three age groups, were reviewed. In axial cross section, the origin of the BT from the aortic arch was identified. The BT origin, with respect to the trachea, was recorded as for a clock face, approximated to the nearest half hour. There were 62 CTs in Group 1 (1 day to 3 years of age), 48 CTs in Group 2 (10-15 years), and 71 examinations in Group 3 (20-40 years). In 96.8% of Group 1, 91.7% of Group 2, and 74.6% of Group 3 the BT origin was to the left of the trachea, between the half past twelve and 3 o'clock positions. The BT origin occurred more the left in Group 1 when compared with the other two groups (P < 0.001). An origin of the BT to the left of the trachea is a normal finding in children and young adults without obstructive respiratory symptoms. There is a tendency for the origin to become progressively more rightward with age.
Topics: Adolescent; Adult; Brachiocephalic Trunk; Child; Child, Preschool; Female; Humans; Infant; Male; Radiography, Thoracic; Reference Values; Tomography, X-Ray Computed; Trachea; Tracheal Diseases; Young Adult
PubMed: 19918870
DOI: 10.1002/ca.20884 -
Presse Medicale (Paris, France : 1983) Jun 2002DIAGNOSTIC CIRCUMSTANCES: Non-iatrogenic traumas of the brachiocephalic arterial trunk (BCAT) are rare. Open traumas predominate and involve the distal half of the... (Review)
Review
UNLABELLED
DIAGNOSTIC CIRCUMSTANCES: Non-iatrogenic traumas of the brachiocephalic arterial trunk (BCAT) are rare. Open traumas predominate and involve the distal half of the artery. Closed traumas are secondary to violent injury with severe deceleration and involve the proximal part of the artery. This diagnosis must be systematically evoked in patients with violent traumas or exhibiting wounds of the thorax and/or base of the neck. Emergency thoracic radiography usually reveals a widening of the mediastinum and a subsequent arteriography is essential for the surgeon. Concomitant lesions are frequent; which complicate diagnosis, prognosis and therapeutic management.
SURGICAL TREATMENT
The approach of choice is cervico-sternotomy. For lesions secondary to an open trauma, direct repair is the usual approach. Treatment of disinsertions, secondary to a closed trauma, requires by-pass between the ascending aorta and the distal part of the BCAT and lateral suture of the aortic cross. POOR PROGNOSIS: However, mortality has decreased over the past 30 years due to the advances in medical imaging and improved medical-surgical management in specialized emergency centres. FISTULAS BETWEEN THE TRACHEA AND THE BCAT: Dramatically complicate tracheotomy. Their diagnosis is usually easy and relies on rigid bronchoscopy in the absence of severe hemorrhage. Treatment is above all preventive. Curative treatment is always urgent and consists in binding the BCAT. Prognosis is poor and often worsened by the underlying pathology.
Topics: Brachiocephalic Trunk; Diagnosis, Differential; Humans; Prognosis; Radiography, Thoracic; Tracheoesophageal Fistula; Tracheotomy; Vascular Surgical Procedures; Wounds and Injuries
PubMed: 12148269
DOI: No ID Found -
The Annals of Thoracic Surgery Mar 1999A common brachiocephalic trunk, in which both common carotid arteries and the right subclavian artery arise from a single trunk off the arch, is a normal variant of...
BACKGROUND
A common brachiocephalic trunk, in which both common carotid arteries and the right subclavian artery arise from a single trunk off the arch, is a normal variant of aortic arch branching that occurs in approximately 10% of the population. Because three of the four primary sources of cerebral blood flow arise from a single aortic branch, stenosis or occlusion of a common trunk can cause severe ischemic consequences. Common trunk revascularization has been described, but there have been no reports focusing on the management options for occlusive disease of this vascular anatomy.
METHODS
A retrospective review of our experience with innominate artery revascularization identified 6 patients who underwent revascularization of a common brachiocephalic trunk between 1977 and 1997. All patients were symptomatic, with either total occlusion (n = 3) or critical stenosis (n = 3) caused by atherosclerosis (n = 5) or Takayasu's arteritis (n = 1). Revascularization was achieved by a prosthetic bypass graft from the ascending aorta to the innominate or left common carotid arteries or both (n = 5); or transarterial endarterectomy (n = 1). Concomitant endarterectomy of branch vessels was performed in 3 patients.
RESULTS
There was one perioperative death from myocardial infarction, and one perioperative stroke, with death occurring 1 month after hospital discharge. One patient developed cerebral hyperperfusion syndrome 1 week after endarterectomy that resolved without sequelae with antihypertensive medications. During a follow-up period ranging from 1 to 20 years, there was one late death from congestive heart failure 5 years after operation. All surviving patients are alive and free from symptomatic recurrence.
CONCLUSIONS
Revascularization for occlusive disease of a common brachiocephalic trunk can be achieved with effective and durable relief of symptoms using either a prosthetic bypass graft or endarterectomy. However, neurologic complications in 2 patients, which were fatal in 1, attest to the potential cerebral ischemic threat posed by occlusive disease of a common brachiocephalic trunk.
Topics: Adult; Aged; Aorta; Arterial Occlusive Diseases; Arteriosclerosis; Brachiocephalic Trunk; Carotid Artery, Common; Female; Humans; Middle Aged; Retrospective Studies; Takayasu Arteritis; Vascular Surgical Procedures
PubMed: 10215206
DOI: 10.1016/s0003-4975(98)01322-8