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

Embolization of an Intracranial Vertebral Artery Aneurysm via the Deep Cervical Artery

Treatment of vertebral artery aneurysms can be challenging due to the unusual vascular anatomy or unfeasibility of traditional endovascular techniques. We describe a novel approach for endovascular treatment of a ruptured intracranial vertebral artery aneurysm with bilateral vertebral artery occlusions and hypoplasia of the posterior communicating arteries. Successful coil embolization was performed using a collateral pathway for microcatheterization via anastomosis between the deep cervical artery and the vertebral artery. This case report highlights a novel alternative endovascular treatment approach for vertebrobasilar aneurysms in case of a poor vascular status with occlusion or lack of traditional endovascular access routes.

The thyrocervical trunk: an analysis of its morphology and variations

The number of studies on the variations of the branching of the TT is scarce, and those works that treat about the different types of the said trunk are oftentimes inconsistent. Therefore, the authors of the present study would like to propose a set of five types of TT, which were created based on observations of 41 computed tomography angiographies (82 TTs). To establish the anatomical variations, their prevalence, and morphometrical data regarding the TT and its branches, a retrospective study was performed. The results of 55 consecutive patients who underwent neck and thoracic computed tomography angiography (CTA) were analyzed. The analysis was performed on a total of 82 TTs of 41 patients, aged 15 to 82 years (mean age: 46 years; SD: 18.4), of which 16 (39.0%) were females, and 25 (61.0%) were males. Initially, 11 types of variations were evaluated, of which types 1-4 constituted 89.0%. Furthermore, a new method of classification of the anatomical variations of the TTs has been established. In this study, the variety of the branching and morphology of the TT was presented, proposing its novel classification based on the five most commonly prevalent types. Types 1 and 2 were the most common, with a prevalence of 26.8% each. This work also provides physicians with crucial data about the morphology of the TT and its branches, which can surely be of use when performing endovascular or reconstructive procedures in the cervical region.

Common trunk of the internal thoracic artery, inferior thyroid artery and thyrocervical trunk from the subclavian artery: a rare arterial variant

PURPOSE

In this article, we describe a complex and rare variant of the common trunk arising as a branch of the subclavian artery. This description highlights the clinical relevance of such a variation for medical practice.

METHODS

A routine dissection was carried out on an adult 74-year-old female cadaver. After identification and preparation of the common trunk, measurements and photographs were taken.

RESULTS

The dissection revealed a common trunk arising from the first part of the left subclavian artery. It divided into the left internal thoracic artery, the inferior thyroid artery, and the thyrocervical trunk. Further on, the branches of the thyrocervical trunk supplied blood to the trapezius muscle, the longus colli muscle and the supraspinatus muscle.

CONCLUSION

For the first time, we report the specific appearance of a common trunk from the left subclavian artery that includes the origin of the left internal thoracic artery, inferior thyroid artery, and thyrocervical trunk. Knowledge of the different variations of subclavian branches is essential because of the high frequency with which this region is involved in diagnostic and surgical procedures.

LEVEL OF EVIDENCE

II Basic Science Research.

A case report of endovascular management of delayed upper gastrointestinal bleeding after open esophagectomy for a benign esophageal stricture

INTRODUCTION

Delayed upper gastrointestinal (GI) bleeding is a rare complication of esophagectomy and can be difficult to manage.

PRESENTATION

A 76-year-old female represented 17 days post open esophagectomy with an unstable upper GI bleed. When control could not be achieved endoscopically, she was transferred to the Radiology Department where a triphasic CT angiogram confirmed active contrast extravasation into the gastric tube. She proceeded to the Interventional Radiology suite where a thoracic angiogram revealed an active arterial bleed from a branch of the thyrocervical trunk. The bleeding vessel was successfully embolised with coils and haemostasis was achieved.

DISCUSSION

Management options for upper GI bleeding post esophagectomy include medical, endoscopic and endovascular approaches.

CONCLUSION

Our case represents a rare example of delayed bleeding into a gastric conduit post open esophagectomy for a benign stricture. The case reinforces.

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

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.

Embolization of Basilar Tip Aneurysm via Ascending Cervical Artery

BACKGROUND

Unusual vascular anatomy can present treatment challenges as traditional approaches may be unfeasible.

CASE DESCRIPTION

In this case we describe a patient who presented with subarachnoid hemorrhage due to a ruptured basilar apex aneurysm, with an occluded left vertebral artery and severely stenotic right vertebral artery. Coil embolization was performed via catheterization of an ascending cervical artery, with a successful clinical and radiographic outcome.

CONCLUSIONS

This demonstrates novel use of an endovascular technique in the setting of multiple vascular pathologies.

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

Patient: Male, 27-year-old

Final Diagnosis: Thyrocervical trunk pseudoaneurysm with recurrent hemothorax

Symptoms: Diaphoresis • lethargy

Medication: —

Clinical Procedure: Coil embolization

Specialty: Surgery

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

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.