Embolization through the thyrocervical trunk: vascular anatomy, variants, and a case series

Pérez-García, Carlos; Malfaz, Carlos; Diéguez, M. del Valle; Gil, Fernando Fortea; Lorente, Javier; Boyra, M. Echenagusia; Leyte, Manuel González; Pérez-Higueras, Antonio; Castro-Reyes, Enrique

doi:10.1136/neurintsurg-2018-013808

Cited by 12 publications

(15 citation statements)

References 11 publications

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“…It is because of these reasons that emergent catheterbased angiography and subsequent embolic occlusion was performed in our patient. Evaluation of a suspected pseudoaneurysm or AVFs may be performed with CTA, which carries a sensitivity and specificity of more than 95% [4]. Duplex sonography has also been shown to provide similar reliability to CTA and MRA (magnetic resonance angiography), but spatial resolution and details of the associated vasculature are limited [5].…”

Section: Discussionmentioning

confidence: 99%

“…Digital subtraction angiography is considered the gold standard and provides vital information regarding collateral vascularization and thyrocervical trunk anastomoses to important neurologic structures. The ascending cervical artery, in particular, has been associated with anastomoses to the vertebral, occipital, and ascending pharyngeal arteries, providing perfusion to the vertebral bodies, spinal cord, and meninges [4]. A feared complication of embolic therapy to the thyrocervical trunk or its branches is an anterior spinal cord infarct, potentially causing complete motor paralysis and the loss of pain and temperature sensation below the lesion, along with possible bowel and sexual dysfunction [4].…”

Section: Discussionmentioning

confidence: 99%

“…The ascending cervical artery, in particular, has been associated with anastomoses to the vertebral, occipital, and ascending pharyngeal arteries, providing perfusion to the vertebral bodies, spinal cord, and meninges [4]. A feared complication of embolic therapy to the thyrocervical trunk or its branches is an anterior spinal cord infarct, potentially causing complete motor paralysis and the loss of pain and temperature sensation below the lesion, along with possible bowel and sexual dysfunction [4]. Involvement of the basilar artery through the anastomoses between the vertebral artery and the ascending cervical artery can lead to coma or death.…”

Section: Discussionmentioning

confidence: 99%

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Traumatic Pseudoaneurysm of the Ascending Cervical Artery Treated with N-butyl Cyanoacrylate Embolization: A Case Report and Review of the Literature

Karsonovich

Hawkins

Gordhan³

2019

Cureus

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Pseudoaneurysms of the thyrocervical trunk and its branches are commonly iatrogenic in nature; however, trauma is often an inciting mechanism. Open surgical repair was considered the main treatment modality until recent advances in endovascular therapy proved to be a viable treatment option. We report a case of a traumatic pseudoaneurysm arising from the ascending cervical artery with an associated arteriovenous fistula (AVF) that was treated using n-butyl cyanoacrylate (NBCA) embolization. The use of a liquid embolysate such as NBCA provided an efficient and effective means of achieving both pseudoaneurysm occlusion and AVF disconnection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Traumatic Pseudoaneurysm of the Ascending Cervical Artery Treated with N-butyl Cyanoacrylate Embolization: A Case Report and Review of the Literature

Karsonovich

Hawkins

Gordhan³

2019

Cureus

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“…Additional etiologies include trauma, infection, and fibromuscular hyperplasia [3]. These vascular anomalies typically present as a painless, pulsatile, supraclavicular mass but can also present as massive hemothorax, recurrent hemothorax, or hemoptysis [4][5][6]. As the aneurysm expands, neurovascular compression of neighboring structures can result in paresthesia (ansa cervicalis), arterial steal syndrome (subclavian artery), or Horner's syndrome (sympathetic trunk).…”

Section: Introductionmentioning

confidence: 99%

Superficial Stab Wound to Zone I of the Neck Resulting in Thyrocervical Trunk Pseudoaneurysm Presented as Recurrent Hemothorax and Successfully Managed by Coil Embolization

et al. 2020

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Objective:Rare disease Background:Thyrocervical trunk pseudoaneurysms are rare complications that have been documented after internal jugular or subclavian venous cannulation. Even less common, these pseudoaneurysms can arise after blunt or penetrating trauma. Clinical hallmarks include an expanding supraclavicular mass with local compressive symptoms such as paresthesias, arterial steal syndrome, and Horner's syndrome. Patients may be asymptomatic, however, or present with overlying ecchymosis or the presence of a new bruit or thrill. With the risk of rupture, thyrocervical trunk pseudoaneurysm is associated with significant morbidity and mortality. Case Report:We report the case of a 27-year-old man who presented after sustaining a self-inflicted stab wound to zone I of his neck. Initial examination revealed only a superficial small laceration, but a chest x-ray revealed a pneumothorax, and tube thoracostomy returned 300 mL of bloody output. After resolution of the hemothorax and removal of the thoracostomy tube, the patient reaccumulated blood, requiring a repeat tube thoracostomy. Angiography at that time revealed a pseudoaneurysm of the thyrocervical trunk, and coil embolization was performed to obliterate the pseudoaneurysm. Conclusions:Thyrocervical trunk pseudoaneurysms can be asymptomatic, often have a delayed presentation, and can be life-threatening due to the risk of rupture and subsequent hemodynamic decline or airway compromise. While these pseudoaneurysms are well-known complications of deep penetrating injuries, they can also present following superficial penetrating injury to zone I of the neck. Selective angiography is the imaging modality of choice. Open surgical repair was traditionally the criterion standard for treatment; however, endovascular approaches are minimally invasive, feasible, and safer alternatives with reduced complications and are becoming more common.

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“…These anastomoses imply the risk of neurological sequelae after the embolisation of the thyrocervical trunk. Pérez-García et al(2019) describes in a wide case series this potential complication in the presence of spinal collateral of thyrocervical artery in endovascular embolisation procedures performed as preoperative treatment for the resection of tumours or as therapy for recurrent haemoptysis, aneurysmal bone cyst and post-traumatic active-bleeding using both microspheres and coils [1]. A paper of Tanizaki et al (2012) presents a similar case of a consistent haemothorax for thyrocervical trunk bleeding in coincidence with a fall treated with coils, but the warning of spinal branches was not mentioned [2] as in an other work where microparticles were used for its embolisation [3].…”

Section: Introductionmentioning

confidence: 99%

Pitfalls in the embolisation of a thyrocervical trunk bleeding: a case report

et al. 2020

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Introduction: An intrathoracic bleeding from the thyrocervical branch is not common in blunt trauma, but an interventional radiologist should be aware of the risks in order to prevent complications. Case presentation: A 30-year-old male presented with a right pneumo-haemothorax due to active bleeding revealed at contrast-enhanced CT, as a consequence of a fall occurred in the previous week. The patient was treated with endovascular embolisation in an angiographic room with coils placement, since the right thyrocervical artery was found to be supplying the pneumo-haemothorax. A radiculo-medullary branch rose from the thyrocervical trunk, impeding the proximal embolization with microparticles and needing selective isolation of the bleeding artery with the catheter to avoid spinal cord injuries. The treatment had a successful result and the following CT control showed signs of recovering, without any complication. Conclusion: Our paper presents a rare contingency, warning the operator to bear in mind the presence of arteries feeding the spinal cord. This crucial detail precludes the use of microparticles embolisation to prevent neurologic sequelae, whereas the use of endovascular coils for embolization should be mandatory. Moreover, this case reminds that the post-traumatic bleeding deriving from a cervical trauma may also occur later.

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Embolization through the thyrocervical trunk: vascular anatomy, variants, and a case series

Cited by 12 publications

References 11 publications

Traumatic Pseudoaneurysm of the Ascending Cervical Artery Treated with N-butyl Cyanoacrylate Embolization: A Case Report and Review of the Literature

Traumatic Pseudoaneurysm of the Ascending Cervical Artery Treated with N-butyl Cyanoacrylate Embolization: A Case Report and Review of the Literature

Superficial Stab Wound to Zone I of the Neck Resulting in Thyrocervical Trunk Pseudoaneurysm Presented as Recurrent Hemothorax and Successfully Managed by Coil Embolization

Pitfalls in the embolisation of a thyrocervical trunk bleeding: a case report

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