Hostname: page-component-6bb9c88b65-vmslq Total loading time: 0 Render date: 2025-07-23T20:47:22.070Z Has data issue: false hasContentIssue false
  • English
  • Français

Protection of high-riding aberrant innominate artery during open tracheotomy

Published online by Cambridge University Press:  19 April 2010

A Netzer ,
D Ostrovsky ,
R Bar ,
S T Westerman  and
A Golz
A Netzer
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Rambam Health Care Campus, The Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
D Ostrovsky
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Rambam Health Care Campus, The Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
R Bar
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Rambam Health Care Campus, The Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
S T Westerman
Affiliation:
Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
A Golz*
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Rambam Health Care Campus, The Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
*
Address for correspondence: Dr Avishay Golz, Department of Otolaryngology-Head and Neck Surgery, Rambam Health Care Campus, PO 9602, Haifa 31096, Israel. Fax: +972 4 8543292 E-mail: golz@netvision.net.il
Get access Rights & Permissions [Opens in a new window]

Abstract

Purpose:

Variations of the normal anatomy of the aortic great vessels can lead to severe complications if not recognised pre- or peri-operatively. One such anomaly is a high-riding aberrant innominate artery.

Study design:

Retrospective review of case series.

Materials and methods:

We present our experience with seven patients in whom a high aberrant innominate artery was encountered just before or during open tracheotomy. We describe a procedure designed to protect the artery from erosion due to the tracheotomy tube, using an inferiorly based, U-shaped flap from the anterior tracheal wall averted over the innominate artery.

Results:

None of the patients had any bleeding from the tracheotomy site, during a follow-up period of nine to 46 months.

Conclusion:

The technique described is simple to perform and prevents any damage to a high aberrant innominate artery, as assessed over a long follow-up period.

Keywords

TracheotomyInnominate Artery

Information

Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 8 , August 2010 , pp. 892 - 895
Copyright
Copyright © JLO (1984) Limited 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1 Oshinsky, AE, Rubin, JS, Gwozdz, CS. The anatomical basis for post-tracheotomy innominate artery rupture. Laryngoscope 1988;98:1061–4CrossRefGoogle ScholarPubMed
2 Upadhyaya, PK, Bertellotti, R, Laeeq, A, Sugimoto, J. Beware of the aberrant innominate artery. Ann Thorac Surg 2008;85:653–4CrossRefGoogle ScholarPubMed
3 Racic, G, Matulic, J, Roje, Z, Dogas, Z, Vilivic, K. Abnormally high bifurcation of the brachiocephalic trunk as a potential operative hazard: case report. Otolaryngol Head Neck Surg 2005;133:811–13CrossRefGoogle ScholarPubMed
4 Ozlugedik, S, Ozcan, M, Unal, A, Yalcin, F, Tezer, MS. Surgical importance of highly located innominate artery in neck surgery. Am J Otolaryngol 2005;26:330–2CrossRefGoogle ScholarPubMed
5 Comert, A, Comert, E, Ozlugedik, S, Kendir, S, Tekdemir, A. High-located aberrant innominate artery: an unusual case of serious hemorrhage of percutaneous tracheotomy. Am J Otolaryngol 2004;25:368–9CrossRefGoogle ScholarPubMed
6 Grant, CA, Dempsey, G, Harrison, J, Jones, T. Tracheo-innominate artery fistula after percutaneous tracheostomy: three case reports and a clinical review. Br J Anaesth 2006;96:227–31CrossRefGoogle Scholar
7 Ridley, RW, Zwischenberger, JB. Tracheoinnominate fistula: surgical management of an iatrogenic disaster. J Laryngol Otol 2006;120:678–80CrossRefGoogle ScholarPubMed
8 Mukadam, GA. Aberrant brachio-cephalic artery precluding placement of tracheostomy. Anaesthesia 2002;57:297–8CrossRefGoogle ScholarPubMed
9 Eliachar, I, Zohar, S, Golz, A, Joachims, HZ, Goldsher, M. Permanent, tracheostomy. Head Neck Surg 1984;7:99–103CrossRefGoogle Scholar
10 Davis, JB, Southwick, HW. Hemorrhage as a postoperative complication of tracheotomy. Ann Surg 1956;144:893–6CrossRefGoogle ScholarPubMed
11 Hori, Y, Hashimoto, S, Katori, Y, Koiwa, T, Hazawa, K, Kobayashi, T. Tracheostomy in tortuous brachiocephalic artery. Nippon Jibiinkoka Gakkai Kaiho 2004;107:152–5CrossRefGoogle ScholarPubMed
12 Jarvis, JK. Displaced brachiocephalic artery: a potential hazard in tracheostomy. S Afr Med J 1966;40:396–7Google ScholarPubMed
13 Maldjian, PD, Saric, M, Tsai, SC. High brachiocephalic artery. CT appearance and clinical implications. J Thorac Imaging 2007;22:192–4CrossRefGoogle ScholarPubMed
14 Dellon, AL, Wells, JH, Cowley, RA. A surgical procedure to prevent tracheo-innominate artery erosion. J Trauma 1978;18:550–3CrossRefGoogle ScholarPubMed
15 Muhammad, JK, Major, E, Wood, A, Patton, DW. Percutaneous dilatation tracheostomy: hemorrhagic complications and the vascular anatomy of the anterior neck. A review based on 497 cases. Int J Oral Maxillofac Surg 2000;29:217–22CrossRefGoogle Scholar
16 Bertram, S, Emshoff, R, Norer, B. Ultrasonographic anatomy of the anterior neck: implications for tracheostomy. J Oral Maxillofac Surg 1995;53:1420–4CrossRefGoogle ScholarPubMed
17 McCormick, B, Manara, AR. Mortality from percutaneous dilatation tracheostomy. A report of three cases. Anaesthesia 2005;60:490–5CrossRefGoogle ScholarPubMed