Post-Tracheostomy Vascular Injury to the Anomalous Thymic Branch Managed by Endovascular Coiling

Background Tracheostomy-related arterial haemorrhage can be devastating especially if arising from an obscure anomalous vessel which can potentially complicate treatment decision. Methods We report a case of non-Hodgkin’s lymphoma with upper airway obstruction, who had profuse bleeding, post-tracheostomy, from the stomal site. CT angiography showed presence of a pseudoaneurysm adjacent to the tracheostomy site which was confirmed on catheter angiography to be arising from anomalous thymic branch of right common carotid artery (CCA). Superselective cannulation of the anomalous thymic artery was done using a microcatheter with subsequent coil embolization. Results Post-coiling, the bleeding stopped immediately and the patient recovered. He was under oncology care till 3 months following embolization and was doing well. Conclusions The emergency physicians should be aware of this rare variation of thymic artery while performing tracheostomy. Ultrasound as point-of-care device may help mitigate these complications. Endovascular embolization is a minimally invasive and effective management option for an injured arterial branch from a tracheostomy.

Acute cerebral microbleeds at the edge of lacunar strokes: cause or result

We investigated the pathogenic relationship between cerebral microbleeds and lacunar strokes. Two cases of lacunar strokes in the region of the basal ganglia, a 72-year-old man and a 67-year-old man, were studied; both cases showed cerebral microbleeds in the stroke areas. The cerebral microbleeds were surrounded by oedema, and the oedema faded out over time, suggesting the cerebral microbleeds had developed acutely. The cerebral microbleeds were located at the ventrolateral edge of the lacunar infarctions, and the locations appeared to be at or near the sites of occlusion of the lenticulostriatal branches. Although a cerebral microbleed and a lacunar infarction may be two unrelated events on juxtapositioned vessels, or a cerebral microbleed may be haemorrhagic conversion of an infarction, a cerebral microbleed could cause an occlusion of the arterial branch, leading to lacunar infarction of its supplying territories.

Ultrasound-Measured Femoral Arterial/Venous Parameters for Guiding Extracorporeal Membrane Oxygenation (ECMO) Catheterization

The femoral artery/vein are commonly used for vascular access in clinical practice. The position, adjoining relationship, and anatomic variation of the femoral artery/vein may affect the success rate of catheterization. Clinically, we found a proportion of anatomic variations in the common position of the femoral artery catheterization. We intended to determine the positioning data of the femoral artery/vein to provide a partial clinical basis for catheterization by ultrasound. At the common femoral artery catheterization site, we used ultrasound to collect data on the femoral artery/vein of 208 samples. We found that the distance from the midpoint of the pubic symphysis to the surface position of the femoral artery, the distance between the central points of the femoral artery/vein, and the inner diameter of the femoral artery were significantly correlated with height, weight, and gender, and were not correlated with age, shock, hypertension, diabetes, and coronary heart disease. If branching of the femoral artery was higher than the inguinal ligament, the inner diameter of the femoral artery at the catheterization site was significantly reduced. We believe that height, weight, gender, and anatomic variation are important factors influencing the adjoining relationship and the inner diameter of the femoral artery. During extracorporeal membrane oxygenation (ECMO) catheterization, if an arterial branch is found at the femoral artery catheterization site, it is recommended to adjust the catheterization protocol.

Pre-Operative Embolisation of an Aberrant Pharyngeal Arterial Branch Arising From the Internal Carotid Artery and Contributing Significantly to the Supply of a Large Juvenile Nasopharyngeal Angiofibroma

Preoperative embolisation of juvenile nasopharyngeal angiofibromas (JNAs) is a well-established treatment that reduces intraoperative blood loss and improves surgical outcomes. While the bulk of arterial supply to the tumour is derived from the external carotid system, some degree of contribution from the internal carotid artery (ICA) is common. ICA branch embolisation in this setting has previously been avoided due to concerns over ischaemic neurological complications, possibly contributing to the increased intraoperative blood loss observed in patients with tumours with ICA supply. There is a marked paucity of reports of embolisation of ICA branches supplying JNA in the medical literature. We present a case of successful embolisation of an aberrant pharyngeal branch of the ascending pharyngeal artery arising from the proximal cervical ICA, which was making a significant contribution to tumour blood supply in a male adolescent with a very large JNA.

CLINICAL ANATOMY OF THE PERFORATING VEINS OFTHE PROXIMAL LOWER LIMBS

Objective. To clarify the topographic and anatomical feature of the perforating veins (PVs) in the proximal part of the lower extremity. Methods. 70 amputated lower extremities from the patients with severe ischemia were subjected to sectional anatomical study; 2800 patients with varicose disease underwent lower extremity sonography. Results. PVs were primarily located on the medial surface of the thigh. In the upper third of the thigh PVs drain into superficial femoral vein. It was detected that one or two PVs occur sin the lower third of the hip draining into superficial femoral vein and originating from the great saphenous vein in 73.6% cases. All PVs were accompanied by an arterial branch from the superficial femoral artery. Anatomical sectional study revealed that a nervous branch accompanied PVs in the lower third of the thigh. Two or four PVs were detected on the lateral surface of the thigh. PVs in the popliteal fossa could be referred to as “atypical” due to their rare occurence (0.4% of cases at sonography) in combination with absent typical sapheno-popliteal junction. PVs in this area were not supported by the intermuscular septa. PVs drained laterally into popliteal vein of the lower limb in 100% cases, while small saphenous vein drained into great saphenous vein in the upper third of the leg or into the intersaphenous vein. Conclusion. Perforating veins constitute perforating bundles (PV, arterial branch, nervous branch), which are predominantly located along the intermuscular septa, which create a constant and strong orientation along the direction of the great vessels. This ensures stable hemodynamics of great vessels and perforating complexes and does not allow squeezed tham togeter during physical exertion. What this paper adds For the first time it has been proved that the perforating veins of the gluteal region pass through the fascia and the thickness of the gluteus maximus muscle and enter the superior and inferior gluteal veins, being transmuscular perforating veins. For the first time it has been established that the location of the femoral perforating veins along the intermuscular septa allows preserving the hemodynamics of the perforating complexes without any squeezed in physical exertion.

Anomalous Origin of the Superior Thyroid Artery from the Internal Carotid Artery

Anatomical anomalies in the human body are common, and their description helps physicians and surgeons during treatment. This article presents the discovery of an abnormal arterial branch originating from the internal carotid artery (ICA). Typically, this artery does not give off branches until it passes through the carotid canal, but during a cadaveric dissection of a 58-year-old female, the superior thyroid artery (STA) was found to be originating from the ICA. Some common variations of the origin of the STA are the common carotid and at the bifurcation of the Common carotid, but rarely, has it been seen origination from the ICA. No known health implication of this variation has been reported, although surgeries can become difficult since the artery is used as an anatomical landmark.

Sphenoidal artery: review of the literature and analysis of a dissected arterially injected fetal orbit

Purpose The sphenoidal artery is considered a component of the complex and dangerous arterial anastomoses of the human orbitocranial region, particularly with the advent of interventional neuroimaging. The objective of this publication was to analyze the various descriptions of the sphenoidal artery in the literature as related to relevant photographs of a dissected arterially injected fetal middle cranial fossa and orbit. Methods Publications dealing with middle meningeal-ophthalmic arterial anastomoses, focusing on the sphenoidal artery, were reviewed. A relevant dissection of a fetal specimen was analyzed. Results The literature dealing with the sphenoidal artery is at times not in agreement. The nomenclature and anatomy of its passage through the superior orbital fissure or Hyrtl canal have variable descriptions. Photographs of the skull base of a dissected arterially injected fetal specimen show bilateral prominent orbital branches of the middle meningeal arteries. These branches entered both orbits in a course similar to the diagrammatic representations of the sphenoidal artery, and give rise to several major intraorbital arteries. This study provides the only photographic image in the literature of this variation in a human fetal anatomic dissection. Conclusions Review of the literature dealing with the sphenoidal artery shows inconsistent nomenclature and conflicting descriptions of its anastomotic connections, and varying evolutionary and embryologic theories. Analysis of the dissected fetal skull base indicates that the sphenoidal artery is not a distinct artery but just a middle meningeal orbital arterial branch, an important component of the complex and dangerous arterial anastomoses of the human orbitocranial region.