Brachiocephalic Trunk ; Fistula/surgery* ; Humans ; Trachea ; Tracheostomy

Tracheo-innominate artery fistula is a rare, but it is one of the gravest complications next to tracheostromy. Early recognition and prompt surgical management is mandatory. The patient was a 66 year old women with MCA infarct who maintained tracheostomy for lyear. She had respiratory arrest due to the excessive bleeding through the tracheostomy site. We report an successful experience for control of bleeding by an innominate artery fistula division and primay suture closure under direct digital compression.
Aged ; Arteries* ; Brachiocephalic Trunk ; Female ; Fistula* ; Hemorrhage ; Humans ; Sutures ; Tracheostomy

Tracheoinnominate artery fistula is a critical complication of tracheostomy. The most important factors influencing patient outcome are prompt diagnosis, immediate control of bleeding with a patent airway, and emergency operation with or without interruption of the innominate artery. Here, we report a case of tracheoinnominate artery fistula in a 40-year-old woman with cerebrovascular accident who was successfully managed with an aorta-axillary artery bypass.
Arteries ; Brachiocephalic Trunk ; Emergencies ; Female ; Fistula ; Hemorrhage ; Humans ; Stroke ; Tracheostomy

Innominate artery injury by blunt chest trauma is rarely reported. This report describes a 40-year-old male who had innominate artery dissection and pseudoaneurysm caused by blunt chest trauma and was treated successfully by ascending aorta to innominate artery bypass graft. The patient recovered without any complications and was discharged one week after the operation.
Adult ; Aneurysm, False ; Aorta ; Brachiocephalic Trunk* ; Humans ; Male ; Thorax* ; Transplants

Although the innominate artery is protected by a bony structure, traumatic injury of this vessel has been reported. These injuries usually occur after blunt chest trauma or sudden deceleration, and are often coupled with other associated injuries. However, we experienced an unusual occurrence where a deceased patient with no history of blunt trauma and no apparent injury on the chest, head, or neck showed an isolated injury of the innominate artery with extensive hemorrhage at the postmortem examination. In the present report, we describe the present case, indicating the characteristics of the innominate artery injury, and review the associated literature.
Autopsy ; Brachiocephalic Trunk ; Deceleration ; Glycosaminoglycans ; Head ; Hemorrhage ; Humans ; Neck ; Thorax

The aortic arch may present a plethora of anatomical variations, which my cause a cluster of complications in interventional procedures in surgery and angiography. We present a rare case of a common origin of both the common carotids arteries from the brachiocephalic trunk (anonymous artery), with the left common carotid artery emerging from the initial portion of it, forming a small common trunk. The great importance towards an excellent knowledge of the topographical aortic arch anatomy is stressed out.
Angiography ; Aorta, Thoracic* ; Arteries ; Brachiocephalic Trunk ; Carotid Artery, Common*

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 (P < 0.05), while the distances from the aortic arch to the brachiocephalic trunk or the cricoid cartilage did not differ significantly between them (P > 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 (P > 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.
Adult ; Female ; Male ; Humans ; Trachea ; Brachiocephalic Trunk ; Larynx ; Cadaver ; Formaldehyde

Localized in vivo proton magnetic resonance spectroscopy (1H-MRS) has been used to measure the metabolic status of the human brain in a non-invasive manner; thus, it is often called "a non-invasive biochemical assay". MRS is more sensitive than magnetic resonance imaging (MRI) in detecting ischemic damage by measuring the metabolic changes that occur prior to the anatomic changes. We report a patient who presented with innominate artery occlusion and symptoms of posterior circulation insufficiency and showed favorable metabolic changes by 1H-MRS after revascularization. He showed no visible lesion in brain MRI, but in 1H-MRS, decreased N-acetylaspartate (NAA) signal was noted in a resting state. After revascularization, both symptomatic improvement and recovery of NAA signal were observed. 1H-MRS may provide valuable clinical information in diagnosis and management of cerebral hypoperfusion at a much earlier stage prior to the anatomic changes.
Arterial Occlusive Diseases/pathology ; Brachiocephalic Trunk/pathology* ; Brachiocephalic Trunk/surgery ; Brain/metabolism* ; Cerebral Revascularization* ; Human ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Protons

A 46-year-old male sustained severe pe- netrating injury by a sharp instrument to his right upper sternoclavicular junction. The wound tract was from suprasternal notch to mediastinum. Exploratory operation via median sternotomy under general anesthesia found a large mediastinal septum hematoncus, as well as brachiocephalic trunk and left brachiocephalic vein injuries. The perforating vascular wounds were repaired with 5-0 prolene suture. He was recovered uneventfully and discharged 9 days after operation. There was no sequel found during 7 years follow-up.
Brachiocephalic Trunk ; injuries ; surgery ; Brachiocephalic Veins ; injuries ; surgery ; Humans ; Male ; Middle Aged ; Sternoclavicular Joint ; injuries ; surgery ; Wounds, Penetrating ; surgery

OBJECTIVE: The aim of this study was to evaluate the utility of volume-rendered helical computerized tomography (CT) angiography focusing tracheostomy tube and innominate artery for prevention of tracheoinnominate artery fistula. METHODS: The authors retrospectively analyzed 22 patients with tracheostomy who had checked CT angiography. To evaluate the relationship between tracheostomy tube and innominate artery, we divided into three categories. First, proximal tube position based on cervical vertebra, named "tracheostomy tube departure level (TTDL)". Second, distal tube position and course of innominate artery, named "tracheostomy tube-innominate artery configuration (TTIC)". Third, the gap between the tube and innominate artery, named "tracheostomy tube to innominate artery gap (TTIG)". The TTDL/TTIC and TTIG are based on 3-dimensional (3D) reconstruction around tracheostomy and enhanced axial slices of upper chest, respectively. RESULTS: First, mean TTDL was 6.8+/-0.6. Five cases (23%) were lower than C7 vertebra. Second, TTIC were remote to innominate artery (2 cases; 9.1%), matched with it (14 cases; 63.6%) or crossed it (6 cases; 27.3%). Only 9% of cases were definitely free from innominate artery injury. Third, average TTIG was 4.3+/-4.6 mm. Surprisingly, in 6 cases (27.3%), innominate artery, trachea wall and tracheostomy tube were tightly attached all together, thus have much higher probability of erosion. CONCLUSION: If low TTDL, match or crossing type TTIC with reverse-L shaped innominate artery, small trachea and thin TTIG are accompanied all together, we may seriously consider early plugging and tube removal.
Angiography ; Arteries ; Brachiocephalic Trunk ; Fistula ; Humans ; Retrospective Studies ; Spine ; Thorax ; Trachea ; Tracheostomy