Anatomical variation in the position of the brachiocephalic trunk (innominate artery) with respect to the trachea: A computed tomography‐based study and literature review of innominate artery compression syndrome

Fawcett, S.; Gomez, Adelaida Ortiz; Hughes, Jacqueline; Set, P. A. K.

doi:10.1002/ca.20884

Cited by 27 publications

(13 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…They found that there was considerable variability in the distance between the subclavian arteries and the cricoid; also, a shorter length of the trachea above the clavicles was associated with closer proximity of the subclavian artery to the cricoid cartilage. Fawcett and colleagues 22 reported CT data on 100 children and 72 adults, finding the brachiocephalic trunk crossed the trachea above the suprasternal notch in 14 out of 48 children less than 3 yr old, but did not report the incidence of this in older children or adults.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of major vessels anterior to the trachea at sites of potential front-of-neck emergency airway access in adults

Weightman

Gibbs

2018

British Journal of Anaesthesia

View full text Add to dashboard Cite

Background: Several case reports have described anatomical variations that can cause difficulty with front-of-neck airway access, such as major vessels anterior to the trachea. The prevalence of these anomalies is unknown. Methods: We screened 500 consecutive thoracic computed tomography (CT) scans in adult patients performed independently in any public hospital in Western Australia. The prevalence of major vessels anterior to the trachea in the anterior triangle of the neck was determined. Results: In the suprasternal notch, 264 CT scans (53%) demonstrated part of a major vessel anterior to the trachea, most commonly the brachiocephalic artery. At 10, 20, and 30 mm above the suprasternal notch, respectively, 126 (25%), 48 (9%), and 5 (1%) CT scans showed a major vessel anterior to the trachea. None showed a major vessel anterior to the cricothyroid membrane. In the suprasternal notch, a major vessel was anterior to the trachea in 10 of 120 CT scans (8%) that had a manubrio-cricoid distance <25 mm, and 108 of 116 CT scans (93%) that had a manubrio-cricoid distance >50 mm. In a logistic-regression model, increased length of trachea above the manubrium was a strong predictor of major vessels anterior to the trachea in the suprasternal notch, whilst sex, age, thoracic kyphosis, tracheal diameter, and the origin of the brachiocephalic artery were not strong predictors. Conclusions: It is common for patients to have some portion of a major vessel anterior to the trachea at sites where an emergency tracheostomy might be performed.

show abstract

Section: Discussionmentioning

confidence: 99%

Prevalence of major vessels anterior to the trachea at sites of potential front-of-neck emergency airway access in adults

Weightman

Gibbs

2018

British Journal of Anaesthesia

View full text Add to dashboard Cite

show abstract

“…In the bleeding group, 3 (1 male) children had major bleeding at mean age 10.3 (range, [4][5][6][7][8][9][10][11][12][13][14][15][16] years. This occurred at a mean time of 3.6 (range, 1-5) years after LTS.…”

Section: Resultsmentioning

confidence: 99%

Tracheoinnominate artery fistula after laryngotracheal separation: prevention and management

Satō

Kawase

Furuta

et al. 2012

Journal of Pediatric Surgery

View full text Add to dashboard Cite

“…The syndrome of brachiocephalic artery compression of the trachea was first reported in 1948 (23, 24, 25). Brachiocephalic artery compression of the trachea represents the most common cause of narrowed airway.…”

Section: Discussionmentioning

confidence: 99%

Obstructive airway in Morquio A syndrome, the past, the present and the future

Tomatsu

Averill

Sawamoto

et al. 2016

Molecular Genetics and Metabolism

105

View full text Add to dashboard Cite

Patients with severe tracheal obstruction in Morquio A syndrome are at risk of dying of sleep apnea and related complications. Tracheal obstruction also leads to life-threatening complications during anesthesia as a result of the difficulty in managing the upper airway due to factors inherent to the Morquio A syndrome, compounded by the difficulty in intubating the trachea. A detailed description of the obstructive pathology of the trachea is not available in the literature probably due to lack of a homogenous group of Morquio A patients to study at any one particular center. We present a series of cases with significant tracheal obstruction who were unrecognized due to the difficulty in interpreting tracheal narrowing airway symptoms. Our goal is to provide the guidelines in the management of these patients that allow earlier recognition and intervention of tracheal obstruction. Sagittal MRI images of the cervical spine of 28 Morquio A patients (12 ± 8.14 years) showed that19/28 (67.9%) patients had at least 25% tracheal narrowing and that narrowing worsened with age (all 8 patients over 15 years had greater than 50% narrowing). Eight out of 28 patients were categorized as severe (>75%) tracheal narrowing when images were evaluated in neutral head and neck position. Of the 19 patients with tracheal narrowing, compression by the tortuous brachiocephalic artery was the most common cause (n = 15). Evidence of such tracheal narrowing was evident as early as at 2 years of age. The etiology of tracheal impingement by the brachiocephalic artery in Morquio A appears to be due to a combination of the narrow thoracic inlet crowding structures and the disproportionate growth of trachea and brachiocephalic artery in relationship to the chest cavity leading to tracheal tortuosity. In conclusion, tracheal narrowing, often due to impression from the crossing tortuous brachiocephalic artery, increases with age in Morquio A patients. Greater attention to the trachea is needed when evaluating cervical spine MRIs as well as other imaging and clinical investigations, with the goal of establishing a timely treatment protocol to reduce the mortality rate in this patient population.

show abstract

Anatomical variation in the position of the brachiocephalic trunk (innominate artery) with respect to the trachea: A computed tomography‐based study and literature review of innominate artery compression syndrome

Cited by 27 publications

References 28 publications

Prevalence of major vessels anterior to the trachea at sites of potential front-of-neck emergency airway access in adults

Prevalence of major vessels anterior to the trachea at sites of potential front-of-neck emergency airway access in adults

Tracheoinnominate artery fistula after laryngotracheal separation: prevention and management

Obstructive airway in Morquio A syndrome, the past, the present and the future

Contact Info

Product

Resources

About