J Korean Neurosurg Soc.  2014 Oct;56(4):353-355. 10.3340/jkns.2014.56.4.353.

Coil Embolization in Ruptured Inferior Thyroid Artery Aneurysm with Active Bleeding

• Lee SH
• Choi HJ
• Yang JS
• Cho YJ

• KMID: 2018089
• DOI: http://doi.org/10.3340/jkns.2014.56.4.353

Abstract

We present a unique experience of urgent parent arterial embolization for treatment of an aneurysm of the inferior thyroid artery (ITA) that bled during tracheostomy. The event happened to a 69-year-old female patient with subarachnoid hemorrhage and hospital-acquired pneumonia that required tracheostomy. Abrupt and massive bleeding developed during the procedure, and the source could not be identified. Under manual compression, angiography revealed an 8-mm aneurysm that arose from the inferior thyroid artery. The superselected parent artery of the aneurysm was successfully occluded with a single pushable coil. The patient's postoperative course was uneventful.

Keyword

Aneurysm; Embolization; Tracheostomy; Hemorrhage

MeSH Terms

Aged
Aneurysm*
Angiography
Arteries*
Embolization, Therapeutic*
Female
Hemorrhage*
Humans
Parents
Pneumonia
Subarachnoid Hemorrhage
Thyroid Gland*
Tracheostomy

Figure

• 

  Fig. 1 Neck computed tomography angiogram immediately after temporary hemostasis showing a saccular aneurysm (arrow) at the inferior thyroid artery.

• 

  Fig. 2 A : Selected angiography into the thyrocervical trunk shows an inferior thyroid aneurysm 8 mm in diameter. B : Immediately after insertion of a single pushable coil into the parent artery, staining of the aneurysmal sac is still visible. C : Ten minutes later, the parent artery is completely occluded. D : Three days after the procedure, no aneurysm is seen on follow-up neck computed tomography angiogram.

Reference

1. Beal SL, Dublin AB, Stone WK. Rupture of inferior thyroid artery aneurysm. J Vasc Surg. 1987; 6:194–196. PMID: 3612969.

2. Debek AH, Jammaleddine GW, Bou-Khalil PK. Inferior thyroid artery injury after attempts of internal jugular venous catheterization. J Cardiothorac Vasc Anesth. 2007; 21:422–424. PMID: 17544900.

3. Ernemann U, Herrmann C, Plontke S, Schäfer J, Plasswilm L, Skalej M. Pseudoaneurysm of the superior thyroid artery following radiotherapy for hypopharyngeal cancer. Ann Otol Rhinol Laryngol. 2003; 112:188–190. PMID: 12597295.

4. Garrett HE Jr, Heidepriem RW 3rd, Broadbent LP. Ruptured aneurysm of the inferior thyroid artery : repair with coil embolization. J Vasc Surg. 2005; 42:1226–1229. PMID: 16376220.

5. Heckenkamp J, Aleksic M, Gawenda M, Krueger K, Reichert V, Brunkwall JS. Endovascular treatment of a ruptured aneurysm of the inferior thyroid artery. Case report and literature review. J Cardiovasc Surg (Torino). 2007; 48:193–196.

6. Karanjia ND, Boulter PS. Aneurysm of the thyrocervical trunk. Eur J Surg. 1992; 158:565–566. PMID: 1360833.

7. Kieu V, Tassone P, Hobbs CG. Successful conservative management of the spontaneous rupture of a superior thyroid artery aneurysm. ANZ J Surg. 2012; 82:371–372. PMID: 23305054.

8. Kim HS, Kim J, Kim EY, Lee SK, Kim DI, Chung WY. Pseudoaneurysm of the inferior thyroid artery presenting as a thyroid nodule. Thyroid. 2009; 19:69–71. PMID: 19072671.

9. Kos X, Henroteaux D, Dondelinger RF. Embolization of a ruptured aneurysm of the inferior thyroid artery. Eur Radiol. 2001; 11:1285–1286. PMID: 11471625.

10. Kramann B, Defreyne L, Schneider G, Müller-Bütow N, Kubale R, Engel M, et al. [Percutaneous embolization therapy in severe cervicofacial hemorrhages]. Rofo. 1997; 166:54–61. PMID: 9072106.

11. Lin HW, Reilly BK. Pseudoaneurysm of the superior thyroid artery following revision tracheostomy. Laryngoscope. 2012; 122:1641–1643. PMID: 22532258.

12. Marrocco-Trischitta MM, Kahlberg A, Calliari F, Chiesa R. Bilateral aneurysm of the inferior thyroid artery. J Vasc Surg. 2007; 45:614. PMID: 17321351.

13. Pop D, Nadeemy S, Venissac N, Aze O, Mouroux J. Ruptured aneurysm of the inferior thyroid artery, which treatment? J Visc Surg. 2011; 148:e227–e228. PMID: 21727055.

14. Selcuk D, Kantarci F, Akgul S, Mihmanli I, Kadioglu P. Partially thrombosed fusiform inferior thyroid artery true aneurysm mimicking a thyroid nodule. J Ultrasound Med. 2006; 25:805–808. PMID: 16731901.

15. Thomas ML, Ammar AD. True aneurysm of the thyrocervical trunk : case report and literature review. Ann Vasc Surg. 2000; 14:677–678. PMID: 11128467.