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[Tracheostomy in tortuous brachiocephalic artery].

Yoko Hori1, Sho Hashimoto, Yukio Katori

  • 1Department of Otolaryngology, Tohoku University School of Medicine, Sendai.

Nihon Jibiinkoka Gakkai Kaiho
|March 23, 2004
PubMed
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Tracheostomy can be complicated by major vessel damage. This case highlights a safe surgical technique for tracheostomy in patients with a tortuous brachiocephalic artery, preventing lethal complications.

Area of Science:

  • Cardiovascular Surgery
  • Pulmonary Medicine
  • Neurosurgery

Background:

  • Tracheostomy is a common procedure for airway management.
  • Potential complications include bleeding, pneumothorax, and major vessel damage.
  • Identifying anatomical variations preoperatively is crucial for surgical safety.

Observation:

  • A 74-year-old female with amyotrophic lateral sclerosis (ALS) presented for tracheostomy.
  • Magnetic resonance (MR) imaging revealed a tortuous brachiocephalic artery anterior to the trachea.
  • A pulsating mass was noted during the physical examination.

Findings:

  • Surgical confirmation of the displaced brachiocephalic artery.
  • A modified tracheostomy technique involved careful vessel dissection and thyroid isthmus division.

Related Experiment Videos

  • An inverted U-shaped tracheal fenestration with a skin flap protected the artery from the tracheostoma.

    • Implications:

    • This case demonstrates a successful approach to tracheostomy in the presence of a tortuous brachiocephalic artery.
    • The described technique minimizes the risk of lethal vascular injury during tracheostomy.
    • Awareness of and careful management of aberrant neck vasculature are essential for safe tracheostomy procedures.