Superior thyroid arteriovenous aneurysm

Abstract

ARTERIOVENOUS aneurvsm is well known as a result larger vessels could have occurred after a straightforward of trauma, but aneirysrn between the superior thyroidectomy. thyroid artery and vein following ligature of the Radiological visualization of the aneurysm was carried superior thyroid pedicle appears to be very unusual. out (J. A. R.). After aneurysm. In order to overcome this difficulty it was decided to use a serial film changer, such as is used in aortography and angiocardiography. Ten C.C. of 50 per cent diaginol were injected rapidly while four films were exposed. It was then clear that the films taken early during injection were the most valuable and the injection was therefore repeated for exposure of a single lateral film at an early phase of injection. The arteriograms clearly show the superior thyroid artery entering the aneurysm, which is drained by a large vein into the inFerna1 jugular vein (Figs. 533, 534). Exploration of the neck was carried out (J. B. 0.) on April 9 through a transverse incision. The sternomastoid was divided, exposing grossly enlarged common facial and internal jugular veins (Fig. 535). It was at first thought that the common facial vein was discharging arterial blood into the internal jugular vein, but further dissection revealed an aneurysm between the superior thyroid artery and vein in the region of the remnant of the left lobe of the thyroid gland (Fig. 536). The artery was ligated close to its origin and the aneurysmal sac was removed with ligature of the superior thyroid vein and common facial vein. The wound was closed around a rubber drain.The patient's symptoms were immediately relieved, and he was perfectly well when last seen in July, 1958. Acknowledgement.-We wish to thank Mr. Lee of the Photographic Department, University of Liverpool, who kindly provided the photographs which were taken during the operation. S O L I T A R Y N O N -P A R A S I T I C C Y S T S O F T H E L I V E R

Arteriovenous aistula following total thyroidectomy treated with angioembolization

“…Some patients remain asymptomatic for years and only present decades later [4]. Only one case has been reported where a true steal phenomenon developed and the patient presented with symptoms of cardiac failure [3]. In this case, the fistula had developed between the thyrocervical trunk and the transverse cervical vein.…”

“…The development of such a phenomenon is assumed to be caused by a penetrating injury to the artery and vein which causes the abnormal communication to develop, as occurs when a suture needle is passed through the vessels for ligation or during en masse suture ligation of the two vessels [2]. The vessels most commonly involved are the superior thyroid artery and the adjacent superior thyroid vein, occasionally the internal jugular vein is directly affected [1,3,5].…”

“…Symptoms are usually mild due to local effects, with patients complaining of a neck mass [3][4][5] , compressive symptoms [3,5] or a buzzing sensation felt in the neck or heard in the ears [3,4]. Some patients remain asymptomatic for years and only present decades later [4].…”

“…Thyroid surgery is a commonly performed surgical procedure with many well recognized complications. Despite the large volume of surgeries performed each year, only 15 cases of an iatrogenic arteriovenous fistula developing post thyroidectomy have been in reported in English literature, dating back to the beginning of the 20th century [1][2][3][4][5]. All reported cases resolved after intervention, which previously mandated surgical excision of the fistula [2][3].…”

“…Despite the large volume of surgeries performed each year, only 15 cases of an iatrogenic arteriovenous fistula developing post thyroidectomy have been in reported in English literature, dating back to the beginning of the 20th century [1][2][3][4][5]. All reported cases resolved after intervention, which previously mandated surgical excision of the fistula [2][3]. With the avaibility of modern imaging machines for diagnosis and skilled interventional radiologist, the minimally invasive approach is preferred and the fistulous communication can be succesfully treated with embolization [1,5].…”