Anatomical relationship between the brachiocephalic trunk and the trachea and the clinical implications / 南方医科大学学报

OBJECTIVE@#To observe the anatomical features and relative position of the brachiocephalic trunk and the trachea to provide an anatomical basis for diagnosis and treatment of mechanical airway obstruction and for facilitating the performance of tracheotomy.@*METHODS@#A total of 91 formalin- fixed adult cadavers (70 male and 21 female) were used in this study. The whole length of the larynx and the trachea were separated and exposed from the neck to the chest, followed by separation of the aortic arch and its 3 branches to observe the anatomical position of the brachiocephalic trunk and the trachea.@*RESULTS@#The brachiocephalic trunk and the trachea did not intersect in 3.30%, partially intersected in 71.43%, and completely intersected in 25.27% of the 91 cadaveric specimens. The male specimens all showed greater outer diameter of the aortic arch, the brachiocephalic trunk and the trachea with a greater length of the trachea than the female specimens (P < 0.05), while the distances from the aortic arch to the brachiocephalic trunk or the cricoid cartilage did not differ significantly between them (P > 0.05). The number of the tracheal cartilage rings above the brachiocephalic trunk ranged from 3 to 10, and the mean number did not differ significantly between the male and female specimens (P > 0.05).@*CONCLUSION@#The brachiocephalic trunk has complex anatomical relationship with the trachea, and caution should be taken to avoid injuries of the brachiocephalic trunk and the aortic arch in the diagnosis and treatment of mechanical respiratory obstruction and during tracheotomy.

Surgical treatment of pseudoaneurysm of the ascending aorta in a patient with sepsis

Abstract Pseudoaneurysm of the ascending aorta (PAA) is a hazardous and potentially fatal cardiovascular disease. This condition is caused by the rupture of at least one layer of the vessel and contained by the remaining vascular layers or the surrounding mediastinal structures. We presented the surgical treatment of a patient with sepsis and large PAA and brachiocephalic trunk, which was compressing the brachiocephalic trunk leading to syncope.

Inversão total do fluxo em artéria carótida interna direita em paciente com estenose grave do tronco braquiocefálico / Total reversal of internal carotid blood flow in a patient with severe stenosis of the brachiocephalic trunk

RESUMO As estenoses graves e oclusões do tronco braquiocefálico (artéria inominada) são raras, e apresentam uma grande variedade de manifestações clínicas, com alterações relacionadas a isquemia cerebral hemisférica, vertebrobasilar e de membro superior direito. A causa mais comum é a aterosclerose. A ultrassonografia vascular com Doppler pode revelar inversão de fluxo na artéria vertebral direita, hipofluxo na subclávia, e vários tipos de alterações no fluxo da carótida direita, incluindo hipofluxo, inversão parcial do fluxo durante o ciclo cardíaco, e até mesmo inversão completa do fluxo na carótida interna, achado este bastante raro. Os autores descrevem o caso de paciente do sexo feminino, tabagista, com estenose grave do tronco braquiocefálico e crises de lipotimia. Além do roubo de artéria subclávia e do fluxo parcialmente invertido na carótida comum direita, a paciente apresentava exuberante fluxo invertido na carótida interna durante todo o ciclo cardíaco, achado este não encontrado na literatura em tamanha magnitude.

ABSTRACT Occlusions and severe stenoses of the innominate artery (brachiocephalic trunk) are rare and present with a wide variety of clinical manifestations, with hemispheric, vertebrobasilar and right upper limb ischemic symptoms. The most common cause is atherosclerosis. Duplex scanning may show right vertebral artery flow reversal, diminished subclavian flow, and several patterns of right carotid flow disturbance, including slow flow, partial flow reversal during the cardiac cycle and even complete reversal of flow in the internal carotid artery, which is a very uncommon finding. Herein, the authors describe the case of a female patient who was a heavy smoker, had severe stenosis of the brachiocephalic trunk, and had episodes of collapse. Besides the subclavian steal and partial flow reversal in the common carotid artery, duplex scanning also showed high-velocity reversed flow in the internal carotid artery during the entire cardiac cycle, a finding that is not reported in the literature at this magnitude.

Técnica del debranching híbrido tipo I del arco aórtico sin circulación extracorpórea / Type I hybrid aortic arch debranching without cardiopulmonary bypass

Los aneurismas del cayado aórtico representan un desafío, ya que el involucramiento de sus grandes ramas exige una técnica quirúrgica compleja. A partir de la aparición del tratamiento endovascular, una alternativa desarrollada en los últimos años para abordar el cayado aórtico consistió en el tratamiento híbrido de esta patología, mediante la derivación quirúrgica de los vasos del cuello y la posterior exclusión del aneurisma con una endoprótesis. Este método híbrido es conocido con el nombre de debranching, y en forma simplificada consiste en realizar, sin circulación extracorpórea, una serie de puentes entre la aorta ascendente y el tronco braquiocefálico, la arteria carótida izquierda y eventualmente la arteria subclavia izquierda, para permitir avanzar una endoprótesis que cubra toda la luz del aneurisma. Se describe la técnica quirúrgica del debranching híbrido tipo I, sin el auxilio de la circulación extracorpórea e implante anterógrado de la endoprótesis, para los aneurismas del cayado aórtico.

Aortic arch aneurysms represent a major challenge as the involvement of the supra-aortic vessels demands a complex surgical technique. Since the advent of endovascular aortic repair, hybrid treatment of aortic arch disease has emerged in recent years. The procedure consists of surgical bypass of the supra-aortic vessels followed by exclusion of the aneurysm with an endograft. This hybrid method is known as debranching and, briefly, consists in performing bypasses between the ascending aorta and the brachiocephalic artery, the left carotid artery and possibly the left subclavian artery without cardiopulmonary bypass, in order to advance an endograft to cover the entire lumen of the aneurysm. The aim of this paper is to describe the surgical technique of type I hybrid debranching without cardiopulmonary bypass and antegrade endograft delivery to treat aortic arch aneurysms.

Anillos vasculares: Serie de 28 pacientes atendidos en un Servicio de Endoscopía Respiratoria Pediátrica / Vascular rings: Series of 28 patients of a Pediatrie Respiratory Endoscopy Department

Los anillos vasculares tienen una incidencia del 1 % entre las enfermedades cardiovasculares congénitas. Constituyen una malformación embriológica en la que el arco aórtico, sus ramas o las arterias pulmonares provocan presión sobre la tráquea y/o el esófago. Anatómicamente, se dividen en dos grupos, dependiendo de cómo rodean la tráquea y el esófago: completo o incompleto. La sintomatología suele iniciarse en los primeros meses de vida con estridor bifásico o espiratorio que aumenta con el llanto y la alimentación, tos traqueal de tonalidad metálica, infecciones respiratorias recurrentes, episodios de apnea refleja y cianosis, sibilancias, hiperextensión cervical, retracción esternal e intercostal, y dificultad en la alimentación. Se realizó un análisis retrospectivo de 28 pacientes con diagnóstico de anillo vascular que concurrieron a la consulta en el Servicio de Endoscopía Respiratoria del Hospital Garrahan entre enero de 2015 y septiembre de 2017.

Vascular rings account for 1 % of the congenital cardiovascular diseases. They constitute an embryological malformation in which the aortic arch, its branches, or the pulmonary arteries cause pressure on the trachea and/or oesophagus. Anatomically, they are divided into two groups -complete or incomplete- depending on how they surround the trachea and/or the oesophagus. Symptom onset is usually in the first months of life with biphasic or expiratory stridor that increases with crying and feeding, a metallic tracheal cough, recurrent respiratory infections, episodes of apnea and cyanosis, wheezing, cervical hyperextension, sternal and intercostal retraction, and feeding difficulties. A retrospective analysis of 28 patients with vascular rings seen at the Department of Respiratory Endoscopy at Garrahan Paediatric Hospital between January 2015 and September 2017 is presented.

Innominate vs. axillary artery cannulation in aortic surgery: a systematic review and meta-analysis

Abstract Objective: To investigate whether axillary artery cannulation has supremacy over innominate artery cannulation in thoracic aortic surgery. Methods: A comprehensive search was undertaken among the four major databases (PubMed, Excerpta Medica dataBASE [EMBASE], Scopus, and Ovid) to identify all randomized and nonrandomized controlled trials comparing axillary to innominate artery cannulation in thoracic aortic surgery. Databases were evaluated and assessed up to March 2017. Results: Only three studies fulfilled the criteria for this meta-analysis, including 534 patients. Cardiopulmonary bypass time was significantly shorter in the innominate group (P=0.004). However, the innominate group had significantly higher risk of prolonged intubation > 48 hours (P=0.04) than the axillary group. Further analysis revealed no significant difference between the innominate and axillary groups for deep hypothermic circulatory arrest time (P=0.06). The relative risks for temporary and permanent neurological deficits as well as in-hospital mortality were not significantly different for both groups (P=0.90, P=0.49, and P=0.55, respectively). Length of hospital stay was similar for both groups. Conclusion: There is no superiority of axillary over innominate artery cannulation in thoracic aortic surgery in terms of perioperative outcomes; however, as the studies were limited, larger scale comparative studies are required to provide a solid evidence base for choosing optimal arterial cannulation site.

Factores que influyen en los resultados de fístula traqueoinnominada I / Influential factors in the results of traqueoinnonate fistula I

Introducción: La fístula traqueoinnominada, aunque poco frecuente, constituye una amenaza potencial para la vida, si no es reconocida y tratada oportunamente. Objetivo: Describir los resultados obtenidos e identificar las acciones que permitan identificarlos. Métodos: Se realizó el estudio retrospectivo, sobre una base de datos prospectiva de pacientes con fístulas traqueonominadas tratados entre 1991 y 2013. Los enfermos se clasificaron según la operación previa: traqueostomía, uso de tubo en T en reintervenciones con intensión de resecar el segmento traqueal estenótico. La revisión de la patogenia y de los métodos diagnósticos permitirán una mejor comprensión para enfrentar esta temible complicación. Se analizan los factores que pudieron influenciar los resultados. Resultados: Cuatro pacientes pertenecían al sexo femenino. Dos tenían una traqueostomía, dos fueron reoperados después de tratamiento con tubo en T; a uno se le realizó resección y anastomosis traqueal y en el otro no fue posible porque se produjo lesión puntiforme traqueal durante la disección mediastinal. Al último se le había colocado un tubo en T, mediante traqueofisura. En dos de tres pacientes, el sangrado centinela se interpretó incorrectamente. En el primero, se consideró que era la consecuencia del tratamiento anticoagulante y en el segundo no se dio valor a la pequeña cantidad de sangre en los esputos. Conclusiones: Un alto índice de sospecha, el diagnóstico temprano y las medidas al pie de la cama: compresión digital y colocación de un tubo ET o una cánula de traqueostomía con el manguito hiperinsuflado, constituyen la única esperanza para estos pacientes(AU)

Introduction: The tracheoinnominate fistula, though a rare entity, is a potential life threat if it is not promptly recognized and treated. Objective: To analyze the influential factors in the results of tracheoinnominate fistula I. Methods: Retrospective study supported on the prospective databases from patients with tracheoinnominate fistulae, who had been treated from 1991 to 2013. They were classified according to their previous surgery: tracheostomy, use of a T-tube or re-interventions aimed at resecting the stenotic tracheal segment. The review of pathogeny and of diagnostic methods allowed a better understanding to face this severe complication. The factors that could have an impact on the results were also analyzed. Results: Four patients were women. Two patients had undergone tracheostomy; two had been reoperated after treatment with T-tube; resection and tracheal anastomosis were performed in one of them but these procedures were not possible to be applied to the other because of a punctiform tracheal lesion during the mediastinal dissection. A T-tube had been placed in this last patient through tracheofissure. The sentinel bleeding in two of three patients was not properly evaluated. In one of them, the bleeding was considered to be the result of anticoagulant treatment whereas in the other, the small amount of blood in the sputum was underassessed. Conclusions: High amount of suspicion, early diagnosis and application of bedside measures such as digital compression, placement of a T-tube or a tracheostomy cannula with overinflated cuff are the only hopeful options for these patients(AU)

Esternotomia parcial para tratamento de lesão iatrogênica do tronco braquiocefálico durante traqueostomia / Partial sternotomy for management of iatrogenic brachiocephalic trunk injury during tracheotomy

A toracotomia mediana é uma via de acesso que atravessa longitudinalmente o esterno e pode ser subdividida em vertical total, parcial superior e parcial inferior. Na prática cirúrgica, o uso da esternotomia mediana parcial é uma alternativa que proporciona menor agressão cirúrgica. O tronco braquiocefálico é um dos grandes vasos torácicos mais acometidos em traumas e sua abordagem classicamente é feita por esternotomia mediana. Neste trabalho, apresenta-se o uso da esternotomia parcial superior em "T" invertido como possibilidade de via de acesso em situação de lesão traumática iatrogênica do tronco braquiocefálico.

The median thoracotomy is an access incision made longitudinally through the sternum and variants can be subdivided into total vertical and partial upper or partial lower vertical incisions. In surgical practice, using a partial median sternotomy is an alternative option that causes less surgical aggression. The brachiocephalic artery is one of the thoracic vessels most often affected in traumas and it can be accessed via a median sternotomy. This report describes use of an upper partial sternotomy to provide access in a case of traumatic iatrogenic injury of the brachiocephalic trunk.

Right and left common carotid arteries arising from the branchiocephalic, a rare variation of the aortic arch / 대한해부학회지

The aortic arch may present a plethora of anatomical variations, which my cause a cluster of complications in interventional procedures in surgery and angiography. We present a rare case of a common origin of both the common carotids arteries from the brachiocephalic trunk (anonymous artery), with the left common carotid artery emerging from the initial portion of it, forming a small common trunk. The great importance towards an excellent knowledge of the topographical aortic arch anatomy is stressed out.

Does the direction of J-tip of the guide-wire influence the misplacement of subclavian catheterization?

OBJECTIVE: Central venous catheter (CVC) misplacement can result in incorrect readings of the central venous pressure, vascular erosion, and intravascular thrombosis. Several studies have examined the correlation between the guidewire J-tip direction and misplacement rate. This study examined whether the guidewire J-tip direction (cephalad vs. caudad) affects the misplacement rate in right subclavian venous catheterization. METHODS: This prospective randomized controlled study was conducted between February 2016 and February 2017. The subjects were divided into two groups (cephalad group vs. caudad group) and the misplacement rate was compared according to guidewire J-tip direction in each group. RESULTS: Of 100 patients, the cephalad and caudad groups contained 50 patients each. The age, sex, and operator experience were similar in the two groups. In the cephalad group, misplacement of CVC insertion into the ipsilateral internal jugular vein occurred in two cases. In the caudad group, misplacement of CVC insertion into the contralateral subclavian vein occurred in one case, with loop formation in the brachiocephalic trunk in one case. Guidewire J-tip direction showed no significant correlation with CVC misplacement. CONCLUSION: The guidewire J-tip direction does not influence the rate of misplacement.

Favorable Aortic Remodeling Following Serial False Lumen Procedures in a Case of Chronic Type IIIb Dissection

We report a case of acute type I aortic dissection in which an emergency graft replacement of the ascending aorta and innominate artery was performed. We performed false lumen thrombosis through hybrid thoracic endovascular aortic repair to seal the primary entry tear, followed by false lumen obliteration at the level of the descending thoracic aorta, abdominal aorta, and right common iliac artery. Over a period of 4.5 years, we used Amplatzer vascular plugs and coils based on our computed tomography angiography follow-up protocol.

Tracheal compression by aberrant brachiocephalic trunk accompanying variant origin of the vertebral artery / Compresión traqueal por un tronco braquiocefálico aberrante acompañado de una variación en el origen de la arteria vertebral

The aorta is the main arterial trunk in the human body, however, its variation was extremely variable. During an educational dissection, aberrant branching pattern of aortic arch was found in a Korean cadaver. The brachiocephalic trunk (innominate artery) originated from the aortic arch at the left side of the trachea. It crossed the trachea and divided into the right common carotid and subclavian arteries. The left vertebral artery originated from the aortic arch between the origins of the left common carotid artery and the left subclavian artery, then the left vertebral artery coursed upward to the transverse foramen of the C7. The author describes this previously novel case report with aberrant brachiocephalic trunk and left vertebral arteries and discusses the clinical implications of such a variant.

La aorta es el tronco arterial principal del cuerpo humano, sin embargo, su variación es extremadamente variable. Durante una disección de rutina de un cadáver coreano, se encontró un patrón de ramificación aberrante del arco aórtico. El tronco braquiocefálico se originaba del arco aórtico en el lado izquierdo de la tráquea. Cruzaba la tráquea y se dividía en las arterias carótida común y subclavia derecha. La arteria vertebral izquierda se originó a partir del arco aórtico entre los orígenes de la arteria carótida común izquierda y la arteria subclavia izquierda, luego la arteria vertebral izquierda ascendió hacia el foramen transversal de la séptima vértebra cervical. Se describe un caso de tronco braquiocefálico aberrante y la correspondiente arteria vertebral izquierda y se discuten las implicaciones clínicas de tal variante.

Collateral branches of the aortic arch in the greater Rhea (Rhea americana americana Linnaeus, 1758) / Ramos colaterais do arco aórtico de emas (Rhea americana americana Linnaeus, 1758)

The greater rhea (Rhea americana americana) is a bird of the Rheidae family, and is known as a ratite for being a flightless bird. This animal has great reproductive and productive potential, according to the products and by-products that it can provide such as meat, leather, feathers and fat which are very popular in the world market. Given its economic importance and lack of information in the literature on its morphology, especially in regard to its cardiovascular apparatus, this study aimed to describe the collateral arteries of the aortic arch, in order to establish the origin and distribution of arteries and thus contribute information to the biology of the species. The bodies of 20 young and adult rheas of both sexes which had died from natural causes and were being stored in a freezer at CEMAS / UFERSA were used. The study was approved by CEUA /UFERSA (Opinion No. 09/2015, process No. 23091.004968 / 2015-23). The animals were thawed and had the cannulated thoracic aorta artery and the vascular system perfused with Neoprene 450 latex colored with yellow pigment. Subsequently, the animals were fixed in 3.7% aqueous solution of formaldehyde, and after 72 hours dissections were carried out, images were obtained and schematic drawings were prepared. The right and left brachiocephalic trunks emerged from the aortic arch in 100% of the specimens from the right brachiocephalic trunk origined a common trunk the thyroid arteries, syringotracheal trunk, vertebral artery, superficial lateral cervical artery, basecervical artery, and ascending esophageal artery. The left brachiocephalic trunk collaterally stemmed in the left common carotid artery, which in turn led to the left internal carotid and a common trunk which stemmed the thyroid arteries, the syringotracheal trunk, vertebral artery, superficial lateral cervical artery, basecervical artery and descending esophageal artery. At the end of its trajectory, the right and left brachiocephalic trunks give rise to the right and left subclavian arteries, which in turn, stem the sternoclavicular, axillary, and intercostal arteries, pectoral trunk, cranial pectoral arteries, pectoral caudal artery and collateral branches of the pectoral trunk. Based on the results, it was concluded that the aortic arch in rheas issued right and left brachycephalic trunks.

A ema (Rhea americana americana) é uma ave da família Rheidae e por isto denominada de ratita, por não apresentar aptidões para o voo. Este animal tem grande potencial reprodutivo e produtivo, em função dos produtos e subprodutos que podem fornecer como carne, couro, penas e gordura muito procurados no mercado mundial. Dada a sua importância econômica e pela falta de informação na literatura sobre sua morfologia, principalmente no que diz respeito ao seu aparelho cardiovascular, objetivou-se descrever os ramos colaterais do arco aórtico, de modo a estabelecer a origem e distribuição destas artérias e, assim, contribuir com informações para a biologia da espécie. Foram utilizadas 20 emas jovens e adultas de ambos os sexos, oriundas do CEMAS/UFERSA, as quais vieram a óbito por causas naturais e que se encontravam armazenadas em freezer. A experimentação foi aprovada pela CEUA/UFERSA (Parecer n° 09/2015, processo n° 23091.004968/2015-23). Os animais foram descongelados e tiveram a artéria aorta torácica canulada e o sistema vascular perfundido com látex Neoprene 450 corado com pigmento amarelo. Posteriormente, os animais foram fixados em solução aquosa de formaldeído a 3,7% e após 72 horas realizaram-se as dissecações e obtenção de imagens fotográficas e elaboração de desenhos esquemáticos. Em 100% dos espécimes, emergiram a partir do arco aórtico os troncos braquiocefálicos direito e esquerdo. O tronco braquiocefálico direito emitiu colateralmente a partir de um tronco comum as artérias tireoide, tronco siringotraqueal, vertebral, cervical superficial lateral, basecervical e esofageana ascendente. Já o tronco braquiocefálico esquerdo emitiu colateralmente a artéria carótida comum esquerda, que por sua vez, originou a carótida interna esquerda e um tronco comum que emitiu as artérias tireoide, tronco siringotraqueal, vertebral, cervical superficial lateral, basecervical e esofageana descendente. No final de seu percurso, os troncos braquiocefálicos direito e esquerdo, originaram as artérias subclávias direita e esquerda, que por sua vez, emitiram as artérias esternoclaviculares, axilar, intercostal, tronco peitoral, peitorais craniais e peitoral caudal e ramos colaterais do tronco peitoral. Com base nos resultados, concluiu-se que, em emas, o arco aórtico emitiu os troncos braquicefálicos direito e esquerdo.

Tonic Investigation Concept of Cervico-vestibular Muscle Afferents

Abstract Introduction Interdisciplinary research has contributed greatly to an improved understanding of the vestibular system. To date, however, very little research has focused on the vestibular system's somatosensory afferents. To ensure the diagnostic quality of vestibular somatosensory afferent data, especially the extra cranial afferents, stimulation of the vestibular balance system has to be precluded. Objective Sophisticated movements require intra- and extra cranial vestibular receptors. The study's objective is to evaluate an investigation concept for cervico-vestibular afferents with respect to clinical feasibility. Methods A dedicated chair was constructed, permitting three-dimensional trunk excursions, during which the volunteer's head remains fixed. Whether or not a cervicotonic provocation nystagmus (c-PN) can be induced with static trunk excursion is to be evaluated and if this can be influenced by cervical monophasic transcutaneous electrical nerve stimulation (c-TENS) with a randomized test group. 3D-video-oculography (VOG) was used to record any change in cervico-ocular examination parameters. The occurring nystagmuses were evaluated visually due to the small caliber of nystagmus amplitudes in healthy volunteers. Results The results demonstrate: no influence of placebo-controlled c-TENS on the spontaneous nystagmus; a significant increase of the vertical nystagmus on the 3Dtrunk- excursion chair in static trunk flexion with cervical provocation in all young healthy volunteers (n = 49); and a significant difference between vertical and horizontal nystagmuses during static trunk excursion after placebo-controlled c-TENS, except for the horizontal nystagmus during trunk torsion. Conclusion We hope this cervicotonic investigation concept on the 3D trunk-excursion chair will contribute to new diagnostic and therapeutic perspectives on cervical pathologies in vestibular head-to-trunk alignment.

Tratamento endovascular de aneurisma de tronco braquiocefálico em paciente com síndrome de Ehlers-Danlos tipo IV / Endovascular treatment of an aneurysm of the brachiocephalic trunk in a patient with Ehlers-Danlos syndrome type IV

Resumo A síndrome de Ehlers-Danlos é uma doença genética que acarreta alteração na síntese de colágeno, causando extrema fragilidade do tecido conjuntivo. Tal fragilidade predispõe a uma série de doenças vasculares, como dissecções, aneurismas e pseudoaneurismas. Os autores relatam o histórico de um indivíduo de 19 anos com aneurisma de tronco braquiocefálico que foi submetido ao tratamento endovascular com implante de stents revestidos. O caso evoluiu com complicação do sítio de punção, que também foi tratada em caráter de emergência pela técnica endovascular com o implante de stent revestido.

Abstract Ehlers-Danlos syndrome is a genetic disease that results in abnormalities of collagen synthesis, causing extremely fragile connective tissue. This fragility predisposes patients to a series of vascular disorders, such as dissections, aneurysms and pseudoaneurysms. The authors describe the case of a 19-year-old patient with an aneurysm of the brachiocephalic trunk who was treated endovascularly by placement of covered stents. The case progressed with complications at the puncture site, which was also treated on an emergency basis, using endovascular techniques with a covered stent.

Ramos colaterais do arco aórtico e suas principais ramificações no cachorro-do-mato (Cerdocyon thous) / Collateral branches of the aortic arch and its main rami in crab-eating fox (Cerdocyon thous)

O cachorro-do-mato (Cerdocyon thous) pertence à família Canidae, encontra-se amplamente distribuído pela América do Sul. Devido à escassez literária a respeito da morfologia desta espécie objetivamos colaborar com o conhecimento da anatomia do arco aórtico e seus ramos colaterais. Foram estudados quatro animais, sendo 2 machos e 2 fêmeas oriundos da Mina de Bauxita, Paragominas, Pará, Brasil/Terra Ltda, sob autorização da SEMA-PA nº 455/2009, que morreram por causas naturais. O sistema arterial foi preenchido com látex corado em vermelho e fixado em solução aquosa de formoldeído 10%. O arco aórtico de Cerdocyon thous apresentou em sua origem apenas dois vasos, o tronco braquiocefálico e a artéria subclávia esquerda. Do tronco braquiocefálico originou-se o tronco bicarotídeo, que se bifurcou nas artérias carótidas comum direita e esquerda, e artéria subclávia direita. Das artérias subclávias ocorreu a formação do tronco costocervical, artéria vertebral, artéria torácica interna, artéria cervical superficial e ao atingir o espaço axilar passa a ser chamada de artéria axilar em ambos os antímeros. Concluímos que o arco aórtico de Cerdocyon thous é similar ao de outros animais domésticos com relação ao número de ramificações em sua origem.(AU)

Crab-eating fox (Cerdocyon thous) belongs to the Canidae family distributed in South America. Due to literary scarcity regarding the morphology of this species, we objectifiked to collaborate with description of the anatomy of the aortic arch and its collateral branches. We studied four foxes, 2 males and 2 females, from Mina Bauxita, Paragominas, Pará, Brazil/Terra Ltda, under authorization of SEMA-PA nº 455/2009, that died of natural causes. The arterial system was filled with red latex and fixation with 10% formaldehyde solution. The aortic arch of Cerdocyon thous showed that in its origin are two vessels, brachiocephalic trunk and left subclavian artery. From brachiocephalic trunk originates the bicarotid trunk, bifurcated into left and right carotid common arteries, and right subclavian artery. The subclavian arteries originates the costocervical trunk, vertebral artery, internal thoracic artery, superficial cervical artery, to reach the axillary space, and passes to be called axillary artery on both sides. We conclude that the aortic arch of Cerdocyon thous is similar to the one in other domestic animals regarding the number of ramificastions at its origin.(AU)

The arteries root from the aortic arch in the sparrowhawk (Accipiter nisus, Falconiformes: Accipitridae) / La raíz de las arterias desde el arco aórtico en el gavilán (Accipiter nisus, Falconiformes: Accipitridae)

This study was aimed at determining the morphology of the aortic arch in the sparrowhawk. For this purpose, arteries near the heart of six sparrowhawks were assessed. Latex injection method was applied to the three materials and barium sulphate solution was injected into the aorta for angiography in three other materials. It was observed that two major arteries arose from aortic arch in the sparrowhawk: the left brachiocephalic trunk and the right brachiocephalic trunk. These trunks were contiguous arteries but separately originated from the aorta. The brachiocephalic trunks were divided into the common carotid and subclavian arteries after their origins. First, the common carotid arteries are given off by the brachiocephalic trunks. The common carotid artery was giving off esophagotracheobronchial artery and vertebral trunk. Vertebral trunk was locating under the brachial plexus. The subclavian artery was continuations of the brachiocephalic trunk and it was bifurcating to the axillar artery and the pectoral trunk just from its own beginning. The axillary artery passed the brachial plexus crosswise from above, and reached to the wing. The sternoclavicular artery stemmed from ventral aspect of the begining of the axillary artery. The thickest branch of the subclavian artery was the pectoral trunk, which was branched the cranial external thoracic artery, the caudal external thoracic artery, the dorsal thoracic artery, and the internal thoracic artery. It is hoped that the results of this morphological study will contribute to the species specific anatomical data in the birds.

El objetivo fue determinar la morfología del arco aórtico en el gavilán. Para este fin, se evaluaron las arterias próximas al corazón de seis gavilanes. En tres aves se inyectó una solución de látex, mientras que en las tres restantes se inyectó a través de la aorta sulfato de bario para someterlas luego a un estudio por angiografía. Se observó el origen de dos arterias principales del arco aórtico del gavilán: el tronco braquiocefálico izquierdo y el tronco braquiocefálico derecho. Estos troncos se presentaron como arterias contiguas, pero que se originaron por separado de la aorta. Los troncos supraaórticos se dividieron después de su origen en las arterias carótida común y subclavia. Las arterias carótidas comunes se emiten a partir de los troncos supraaórticos. La arteria carótida común emitió una arteria esófago-traqueobronquial y el tronco vertebral. El tronco vertebral se localizó por debajo del plexo braquial. La arteria subclavia se continuó a partir del tronco braquiocefálico y se bifurcó en arteria axilar y tronco de las arterias pectorales justo desde su propio inicio. La arteria axilar cruzó el plexo braquial transversalmente desde arriba, y llegó al ala. La arteria esternoclavicular derivó de la cara ventral del inicio de la arteria axilar. La rama más gruesa de la arteria subclavia fue el tronco de las arterias pectorales, que se ramificó en arteria torácica externa craneal, arteria torácica externa caudal, arteria torácica dorsal, y la arteria torácica interna. Se espera que los resultados de este estudio morfológico sean una contribución para aportar datos anatómicos específicos en esta especie de aves.

Un caso de aneurisma aórtico / A case of aortic aneurysm

Hoy me permito, de manera muy sencilla, relatar un caso de aneurisma con dilatación aórtica que se estudió y trató con el servicio de San Roque en 1928. Se trataba de una enferma de 60 años de edad, natural de Bogotá, hospitalizada el 3 de febrero de 1928 y que quise conservar en el servicio por referirse a una lesión que me llamaba particularmente la atención. Llegó con alguna ligera gripa y no dio antecedentes de mayor importancia. Tuvo fiebre tifoidea en su juventud, no había presentado sino un traumatismo de escasa importancia, y solo había padecido novedades de poca significación. La enferma, en el momento del primer examen, estaba en el lecho en decúbito dorsal, se la notaba algo pálida, pero tenía un aspecto de absoluta tranquilidad, sin fatiga, dolor ni malestar ninguno; contestaba bien a las preguntas y manifestaba haber tenido solamente cefalalgia y dolores óseos nocturnos De la presente observación sacamos las conclusiones siguientes: es mucho lo que sirve para el jefe del servicio y para su ayudante la observación atenta y pormenorizada que se consigna en una observación escrita con relación a cada enfermo; cómo sirve para el hospital este trabajo para facilitar los diagnósticos y hacer más seguro el tratamiento; así como la importancia de la autopsia en muchos casos, tanto para el progreso científico como para aclarar diagnósticos dudosos...(AU)

Surgical Management of Aorto-Esophageal Fistula as a Late Complication after Graft Replacement for Acute Aortic Dissection

A 49-year-old male presented with chills and a fever. Five years previously, he underwent ascending aorta and aortic arch replacement using the elephant trunk technique for DeBakey type 1 aortic dissection. The preoperative evaluation found an esophago-paraprosthetic fistula between the prosthetic graft and the esophagus. Multiple-stage surgery was performed with appropriate antibiotic and antifungal management. First, we performed esophageal exclusion and drainage of the perigraft abscess. Second, we removed the previous graft, debrided the abscess, and performed an in situ re-replacement of the ascending aorta, aortic arch, and proximal descending thoracic aorta, with separate replacement of the innominate artery, left common carotid artery, and extra-anatomical bypass of the left subclavian artery. Finally, staged esophageal reconstruction was performed via transthoracic anastomosis. The patient's postoperative course was unremarkable and the patient has done well without dietary problems or recurrent infections over one and a half years of follow-up.

Endovascular stenting of tracheoinnominate fistula after tracheostomy in a 14-year-old boy / 소아과

Tracheoinnominate artery fistula is a rare, fatal complication of tracheostomy, and prompt diagnosis and management are imperative. We report the case of tracheoinnominate artery fistula after tracheostomy in a 14-year-old boy with a history of severe periventricular leukomalacia, hydrocephalus, cerebral palsy, and epilepsy. The tracheoinnominate artery fistula was successfully treated with a stent graft insertion via the right common femoral artery. Endovascular repair of the tracheoinnominate artery fistula via stent grafting is a safe, effective, and minimally invasive treatment for patients in poor clinical conditions and is an alternative to traditional open surgical treatment.