Brachiocephalic trunk damage resulted from percutaneous tracheotomy

Abstract

StreszczenieW pracy przedstawiono rzadki przypadek uszkodzenia ściany pnia ramienno-głowowego podczas wykonywania przezskórnej tracheotomii. Przypadek dotyczył mężczyzny będącego w ciężkim stanie ogólnym po nagłym zatrzymaniu krążenia. W trakcie hospitalizacji na oddziale intensywnej terapii doznał krwawienia w okolicy i z rurki intubacyjnej, a po kolejnym epizodzie masywnego krwawienia zmarł. Sekcyjnie stwierdzono, że źródłem krwawienia było uszkodzenie pnia ramienno-głowowego.Słowa kluczowe: pień ramienno-głowowy, powikłania, przezskórna tracheostomia, PTD. AbstractThe 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.

Esternotomia parcial para tratamento de lesão iatrogênica do tronco braquiocefálico durante traqueostomia

“…7 Factors that increase the risk of severe hemorrhage include percutaneous tracheotomies conducted without monitoring by bronchoscopy, low incisions, coagulopathies, and prior surgical procedures and radiotherapy involving the neck. 4 During the tracheotomy, the surgeon should bear in mind the possible anatomic variations of adjacent vessels (brachiocephalic vessels, subclavian vessels, common carotids, and jugulars) that can increase the risk of iatrogeny. 4,5 While hemorrhage caused by injuries to the brachiocephalic trunk is rare during tracheotomy, 4 this artery is the second most frequently injured of the major thoracic vessels when non-iatrogenic traumas are analyzed, occurring in approximately 9% of penetrating wounds to the thorax.…”

“…4 During the tracheotomy, the surgeon should bear in mind the possible anatomic variations of adjacent vessels (brachiocephalic vessels, subclavian vessels, common carotids, and jugulars) that can increase the risk of iatrogeny. 4,5 While hemorrhage caused by injuries to the brachiocephalic trunk is rare during tracheotomy, 4 this artery is the second most frequently injured of the major thoracic vessels when non-iatrogenic traumas are analyzed, occurring in approximately 9% of penetrating wounds to the thorax. Among venous injuries, the left brachiocephalic vein is involved three times more often than the right, because of its greater size and its position crossing the upper mediastinum.…”

“…While venous bleeding is more common, arterial injuries with massive bleeding can also occur. 4 The brachiocephalic arterial trunk is the largest caliber branch of the aortic arch; its location and contact with adjacent structures makes it susceptible to trauma in many different situations. Although a rare complication, iatrogenic injury to this vessel can occur during tracheotomy.…”

“…Although a rare complication, iatrogenic injury to this vessel can occur during tracheotomy. [4][5][6] The brachiocephalic trunk is one of the major thoracic vessels that is most often damaged by trauma. The classical approach is via a median sternotomy, which can be extended to cervicotomy.…”