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

Abstract

A correct knowledge of the vascular anatomy, anatomical variants, and anastomosis (especially with the anterior spinal artery) of the TCT is essential for a safe embolization, both preoperatively and on an emergency basis. In cases of recurrent hemoptysis and severe lower-neck injuries, the TCT should always be reviewed.

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

“…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].…”

“…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].…”

“…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.…”

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

“…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).…”

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

“…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].…”