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

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

We report a case of acute type I aortic dissection in which an emergency graft replacement of the ascending aorta and innominate artery was performed. We performed false lumen thrombosis through hybrid thoracic endovascular aortic repair to seal the primary entry tear, followed by false lumen obliteration at the level of the descending thoracic aorta, abdominal aorta, and right common iliac artery. Over a period of 4.5 years, we used Amplatzer vascular plugs and coils based on our computed tomography angiography follow-up protocol.
Angiography ; Aorta ; Aorta, Abdominal ; Aorta, Thoracic ; Brachiocephalic Trunk ; Emergencies ; Follow-Up Studies ; Iliac Artery ; Tears ; Thrombosis ; Transplants ; Vascular Remodeling

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: Central venous catheter (CVC) misplacement can result in incorrect readings of the central venous pressure, vascular erosion, and intravascular thrombosis. Several studies have examined the correlation between the guidewire J-tip direction and misplacement rate. This study examined whether the guidewire J-tip direction (cephalad vs. caudad) affects the misplacement rate in right subclavian venous catheterization. METHODS: This prospective randomized controlled study was conducted between February 2016 and February 2017. The subjects were divided into two groups (cephalad group vs. caudad group) and the misplacement rate was compared according to guidewire J-tip direction in each group. RESULTS: Of 100 patients, the cephalad and caudad groups contained 50 patients each. The age, sex, and operator experience were similar in the two groups. In the cephalad group, misplacement of CVC insertion into the ipsilateral internal jugular vein occurred in two cases. In the caudad group, misplacement of CVC insertion into the contralateral subclavian vein occurred in one case, with loop formation in the brachiocephalic trunk in one case. Guidewire J-tip direction showed no significant correlation with CVC misplacement. CONCLUSION: The guidewire J-tip direction does not influence the rate of misplacement.
Brachiocephalic Trunk ; Catheterization* ; Catheters* ; Central Venous Catheters ; Central Venous Pressure ; Humans ; Jugular Veins ; Prospective Studies ; Reading ; Subclavian Vein ; Thrombosis

Tracheoinnominate artery fistula is a rare, fatal complication of tracheostomy, and prompt diagnosis and management are imperative. We report the case of tracheoinnominate artery fistula after tracheostomy in a 14-year-old boy with a history of severe periventricular leukomalacia, hydrocephalus, cerebral palsy, and epilepsy. The tracheoinnominate artery fistula was successfully treated with a stent graft insertion via the right common femoral artery. Endovascular repair of the tracheoinnominate artery fistula via stent grafting is a safe, effective, and minimally invasive treatment for patients in poor clinical conditions and is an alternative to traditional open surgical treatment.
Adolescent* ; Angioplasty ; Arteries ; Blood Vessel Prosthesis ; Brachiocephalic Trunk ; Cerebral Palsy ; Diagnosis ; Epilepsy ; Femoral Artery ; Fistula* ; Humans ; Hydrocephalus ; Infant, Newborn ; Leukomalacia, Periventricular ; Male* ; Stents* ; Tracheostomy*

A 49-year-old male presented with chills and a fever. Five years previously, he underwent ascending aorta and aortic arch replacement using the elephant trunk technique for DeBakey type 1 aortic dissection. The preoperative evaluation found an esophago-paraprosthetic fistula between the prosthetic graft and the esophagus. Multiple-stage surgery was performed with appropriate antibiotic and antifungal management. First, we performed esophageal exclusion and drainage of the perigraft abscess. Second, we removed the previous graft, debrided the abscess, and performed an in situ re-replacement of the ascending aorta, aortic arch, and proximal descending thoracic aorta, with separate replacement of the innominate artery, left common carotid artery, and extra-anatomical bypass of the left subclavian artery. Finally, staged esophageal reconstruction was performed via transthoracic anastomosis. The patient's postoperative course was unremarkable and the patient has done well without dietary problems or recurrent infections over one and a half years of follow-up.
Abscess ; Aorta ; Aorta, Thoracic ; Brachiocephalic Trunk ; Carotid Artery, Common ; Chills ; Drainage ; Elephants ; Esophagus ; Fever ; Fistula* ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Subclavian Artery ; Transplants*

PURPOSE: The aim of this study was to introduce the phenomenon that stenosis or occlusion occurs less frequently in the innominate artery than in the right subclavian and common carotid arteries, which are not first-order branches of the aorta, in Takayasu arteritis (TA). MATERIALS AND METHODS: We retrospectively reviewed the medical records and image findings of all patients who were diagnosed with TA from 2006 to 2014. Two vascular surgeons and two radiologists interpreted the images by disease character, location, and extent of occlusion based on computed tomography angiography, magnetic resonance angiography, or digital subtraction arteriography. We have also reviewed the literature on arterial involvement in TA. RESULTS: A total of 42 patients were diagnosed with TA. The mean age was 43.9 years, and 83.3% (35/42) of the patients were women. The left subclavian artery was the most common stenosis or occlusion site (17, 40.5%) among the aortic branches. The innominate artery was a less common site (3, 7.1%) than the right subclavian artery (4, 9.5%) and the right common carotid artery (9, 21.4%). All innominate artery cases were found after endovascular procedures of the right subclavian or common carotid arteries. CONCLUSION: The innominate artery might develop stenosis or occlusion less frequently than the right subclavian and common carotid arteries in Korean TA patients.
Angiography ; Aorta ; Brachiocephalic Trunk* ; Carotid Artery, Common* ; Cerebrovascular Disorders ; Constriction, Pathologic* ; Endovascular Procedures ; Female ; Humans ; Magnetic Resonance Angiography ; Medical Records ; Retrospective Studies ; Subclavian Artery ; Takayasu Arteritis*

OBJECTIVETo summarize the experience of treating aortic arch disease with ascending aorta to carotid artery revascularization and subsequent endovascular repair.

METHODSFrom January 2002 to June 2013, 10 high risk patients with aortic arch disease were treated with ascending aorta to carotid artery revascularization with subsequent endovascular repair in the First Affiliated Hospital, Sun Yat-sen University. There were 9 male and 1 female patients with a mean age of (54 ± 14) years (ranging from 34 to 71 years). Of the 10 patients, 8 were aortic dissection and 2 were thoracic aortic aneurysm. All aortic arch debranching was performed with mid-sternotomy, including 7 ascending aorta to innominate artery and left common carotid artery bypass, and 3 ascending aorta to left common carotid artery and left subclavian artery bypass.Subsequently, simultaneous (n = 5) and staged (n = 5, mean interval (7 ± 4) days) endovascular repair were performed via femoral artery.

RESULTSTechnical success rate was 10/10. The 30 day-mortality was 3/10, including 1 brain stem infarction, 1 circulatory failure and 1 aorto-tracheal fistula. Complication included 1 type II endoleak. The median time of follow-up was 24 (14) months. CT scanning was performed at 1, 3 months and annually thereafter. There was no death and no occlusion of bypass during follow-up.No complication occurred except 1 existing type II endoleak.

CONCLUSIONAscending aorta to carotid artery revascularization with subsequent endovascular repair is suitable for high risk aortic arch pathology patients in poor general condition with little tolerance to aortic arch replacement.

Adult ; Aged ; Aneurysm, Dissecting ; Aorta ; Aortic Aneurysm ; Aortic Aneurysm, Thoracic ; Aortic Diseases ; surgery ; Blood Vessel Prosthesis Implantation ; Brachiocephalic Trunk ; Carotid Artery, Common ; Endoleak ; Endovascular Procedures ; Female ; Femoral Artery ; Humans ; Male ; Middle Aged ; Sternotomy ; Subclavian Artery ; Tomography, X-Ray Computed ; Vascular Surgical Procedures ; Wound Healing

No abstract available.
Acute Disease ; Adult ; Arteriovenous Fistula/diagnosis/*etiology/surgery ; Brachiocephalic Trunk/*injuries/radiography/surgery/ultrasonography ; Brachiocephalic Veins/*injuries/radiography/surgery/ultrasonography ; Dislocations/*surgery ; Echocardiography, Doppler, Color ; Female ; Heart Failure/diagnosis/*etiology ; Humans ; *Iatrogenic Disease ; Orthopedic Procedures/*adverse effects ; Reoperation ; Sternoclavicular Joint/*surgery ; Tomography, X-Ray Computed ; Treatment Outcome ; Vascular System Injuries/diagnosis/*etiology/surgery