Abstract
BackgroundBrachiocephalic trunk (BCT) variants may have a clinical impact during surgical procedures, some of which could be fatal. The objective of this study was to classify height positions of the BCT and report their prevalence in a Mexican population.MethodsPatients: A retrospective, descriptive, observational, and cross-sectional was performed using computed tomography angiography (CTA) of adult (> 18 years of age) patients, without gender distinction, of Mexican origin. Measuring techniques were standardized using the suprasternal notch to analyze linear and maximum heights, linear and curved lengths, and the vertebral origin and bifurcation levels of the BCT.ResultsA total of 270 CTA were obtained (66.7% men and 33.3% women). A high position of BCT was present in 64.81% (n 175/270). The mean linear medial height was 0.58 ± 1.91 cm, the maximum height of the free edge was 3.85 ± 2.04 cm, side length of the midline at the maximum height of the free edge was 1.46 ± 2.59, linear length 3.72 ± 0.70, and a curve length 3.99 ± 0.79. The BCT origin was most predominant at the T3 (57.9%) and T4 (27.0%) vertebral levels, with the bifurcation at T2 (57.9%) and T1 (36.2%).ConclusionsThere is a high prevalence of high position BCT in our population. Patients should be assessed before any procedures in the area, due to the potential risk of complications.
Highlights
Brachiocephalic trunk (BCT) variants may have a clinical impact during surgical procedures, some of which could be fatal
Computed tomography angiography (CTA) studies of head and neck were obtained from the database of the Radiology and Image Department of the University Hospital “Dr José Eleuterio González.”
The brachiocephalic trunk was considered high-lying position when it exceeded the suprasternal notch without having bifurcated into its terminal branches; Table 1 represents our classification of the BCT reached heights
Summary
Brachiocephalic trunk (BCT) variants may have a clinical impact during surgical procedures, some of which could be fatal. The BCT does not branch other arteries, reports of the inferior thyroid, thymus, and bronchial branches have been described [11,12,13,14] It is classified as a high-lying (prolonged) when if bifurcates cephalic to the sternoclavicular junction. This anatomical variant has been gradually recognized, reported by radiological studies with a prevalence of 3 to 26.4%, and has been correlated with potential surgical complications such as fistulas and bleeding in neck procedures, thyroid surgery, mediastinoscopy, percutaneous tracheotomy, subclavian catheters, among others [15,16,17]. The surgical procedure of choice is aortopexy [15, 22], which consists of the suture of the adventitia of the aorta to the sternum, performed with simultaneous evaluation of the tracheal lumen [16, 23, 24]
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