Kosin Med J.  2022 Jun;37(2):169-172. 10.7180/kmj.21.046.

Tracheostomy with aortic debranching: a case report

• Choi JH
• Lee H

• KMID: 2532048
• DOI: http://doi.org/10.7180/kmj.21.046

Abstract

Percutaneous dilatational tracheostomy (PDT) is preferred over conventional surgical tracheostomy for prolonged airway protection and mechanical ventilation. However, despite its advantages, severe PDT-related complications have been reported, including catastrophic hemorrhage from common carotid artery laceration and innominate artery pseudo-aneurysm. PDT can typically be applied to the trachea, which is the focal point for the transverse course of great vessels (e.g., the anomalous brachiocephalic trunk, which overlaps with the targeted lesion anteriorly); therefore, to improve patient outcomes, an alternative method using aortic debranching may be considered.

Keyword

Aorta; Case reports; Tracheostomy

Figure

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  Fig. 1. A computed tomography scan showed a high-riding anomalous brachiocephalic trunk that crossed the tracheostomy target in the midline on the trachea.

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  Fig. 2. Aortic debranching technique. (A) Reverse T-shaped partial sternotomy and a separate right supraclavicular incision. (B) Post-anastomotic configuration of the reconstructed brachiocephalic trunk using a Y graft that was made at our institution and comprised 10-mm and 8-mm Hemashield grafts for the right subclavian artery and common carotid artery, respectively, after debranching.

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  Fig. 3. Postoperative status. (A) Wound and (B) computed tomography scan.

Reference

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