Background: There are recognised variations in the anatomical course of the cervical portion of the internal carotid artery. An aberrant vessel with direct contact to the pharyngeal wall could easily be injured during...Background: There are recognised variations in the anatomical course of the cervical portion of the internal carotid artery. An aberrant vessel with direct contact to the pharyngeal wall could easily be injured during pharyngeal surgery or may appear as a pharyngeal pseudo mass. Previous anatomical studies predominantly involved older patients. The prevalence of such variations which are at risk of injury during pharyngeal surgery has thus not been established in a general patient population. Material and Methods: The course of the internal carotid artery in relation to the oro and hypopharyngeal walls was retrospectively evaluated bilaterally by simple visual inspection and measurement of the smallest distance between the respective vessels and the adjacent mucosal surface of the pharyngeal wall in 138 consecutive contrast-enhanced computed tomography scans of the neck. Results: 11/138 (7.9%) of patients demonstrated relevant cervical carotid artery aberrations, comprising medial kinking of a vessel with asymmetry of the adjacent pharyngeal lumen and/or an intimate submucous course in the pharyngeal wall with no identifiable separating fat plane. This prevalence increased with age. Simple visual inspection correlated well with the measurement of the smallest distance between an artery and the pharyngeal wall, which was statistically significant (p Conclusions: The prevalence of about 8% in a general patient population is higher than previously recorded in anatomical studies. Prevalence increases with age. Otorhinolaryngologists should be aware of such variation as a risk factor for haemorrhagic complications during pharyngeal surgery and as a differential diagnosis of pharyngeal mass lesions, especially in older patients. Modern contrast-enhanced CT allows identification and characterisation of any surgically relevant variant vascular anatomy in the pre-operative work-up.展开更多
Background:Vascular access used for pediatric cardiac catheterization is one of the most important factors that affects the success of the procedure.We aimed to compare the effect,success,and complications of cardiac ...Background:Vascular access used for pediatric cardiac catheterization is one of the most important factors that affects the success of the procedure.We aimed to compare the effect,success,and complications of cardiac catheterizations performed by carotid cut-down or femoral puncture in newborns or young infants.Methods:We included who underwent catheterization in our department between 28 January 2017 and 15 April 2021.These patients underwent balloon aortic valvuloplasty,balloon coarctation angioplasty,ductal stenting,diagnostic procedures for aortic arch pathologies,and modified Blalock-Taussig in-shunt intervention.Patients were divided into two groups:femoral puncture(group=1)and carotid cut-down(CC,group=2).Results:Seventy-two catheterization procedures were performed in 64 patients;32(44.4%)were performed via the femoral approach and 40(55.6%)were performed via the carotid approach.Sixteen(22.2%)procedures were diagnostic and 56(77.8%)procedures were interventional.CC was performed in 13(32.5%)patients with failed femoral intervention.Patients in the CC group had shorter durations of procedure,vascular access,and anesthesia,compared with the femoral access group(80.9 and 116.2 min,p=0.001;12.9 and 22.5 min,p=0.001;140.9 and 166.6 min,p=0.001,respectively).Patients who underwent CC had fewer complications than did patients in the femoral access group(2.5%and 21.8%,respectively;p=0.01);larger sheats were used in CC patients(p=0.028).Conclusion:The carotid artery can be successfully used as a primary catheterization route,particularly in patients with small body weight and patients who require rapid vascular access,or stenting of the vertical duct.展开更多
BACKGROUND Carotid blowout syndrome(CBS)refers to rupture of the extracranial carotid artery and its branches;as a severe complication,it usually occurs after surgery or radiotherapy for malignant tumours of the head ...BACKGROUND Carotid blowout syndrome(CBS)refers to rupture of the extracranial carotid artery and its branches;as a severe complication,it usually occurs after surgery or radiotherapy for malignant tumours of the head and neck.We present a case of CBS caused by chronic infection of the external carotid artery(ECA).In this case,we did not find any evidence of head and neck tumours.CASE SUMMARY A 42-year-old man was referred to the Emergency Department with a complaint of a lump found on the left side of his neck with pain and fever for 4 d.We diagnosed the condition as neck infection with abscess formation based on physical examination,routine blood examination,ultrasound examination and plain computed tomography(CT)and decided to perform emergency surgery.During the operation,30 mL of grey and smelly pus was drained from the deep surface of the sternocleidomastoid muscle.The second day after the operation,the patient suddenly exhibited a large amount of haemoptysis and incision bleeding.The enhanced CT showed distal occlusion of the left ECA and irregular thickening of the broken ends of the artery encased in an uneven enhancement of soft tissue density.Infected ECA occlusion and rupture were considered.The patient was transferred to a vascular unit for transcatheter ECA embolization and recovered well.CONCLUSION Surgeons need to pay attention to vascular lesions caused by chronic infection that may develop into acute CBS.展开更多
文摘Background: There are recognised variations in the anatomical course of the cervical portion of the internal carotid artery. An aberrant vessel with direct contact to the pharyngeal wall could easily be injured during pharyngeal surgery or may appear as a pharyngeal pseudo mass. Previous anatomical studies predominantly involved older patients. The prevalence of such variations which are at risk of injury during pharyngeal surgery has thus not been established in a general patient population. Material and Methods: The course of the internal carotid artery in relation to the oro and hypopharyngeal walls was retrospectively evaluated bilaterally by simple visual inspection and measurement of the smallest distance between the respective vessels and the adjacent mucosal surface of the pharyngeal wall in 138 consecutive contrast-enhanced computed tomography scans of the neck. Results: 11/138 (7.9%) of patients demonstrated relevant cervical carotid artery aberrations, comprising medial kinking of a vessel with asymmetry of the adjacent pharyngeal lumen and/or an intimate submucous course in the pharyngeal wall with no identifiable separating fat plane. This prevalence increased with age. Simple visual inspection correlated well with the measurement of the smallest distance between an artery and the pharyngeal wall, which was statistically significant (p Conclusions: The prevalence of about 8% in a general patient population is higher than previously recorded in anatomical studies. Prevalence increases with age. Otorhinolaryngologists should be aware of such variation as a risk factor for haemorrhagic complications during pharyngeal surgery and as a differential diagnosis of pharyngeal mass lesions, especially in older patients. Modern contrast-enhanced CT allows identification and characterisation of any surgically relevant variant vascular anatomy in the pre-operative work-up.
文摘Background:Vascular access used for pediatric cardiac catheterization is one of the most important factors that affects the success of the procedure.We aimed to compare the effect,success,and complications of cardiac catheterizations performed by carotid cut-down or femoral puncture in newborns or young infants.Methods:We included who underwent catheterization in our department between 28 January 2017 and 15 April 2021.These patients underwent balloon aortic valvuloplasty,balloon coarctation angioplasty,ductal stenting,diagnostic procedures for aortic arch pathologies,and modified Blalock-Taussig in-shunt intervention.Patients were divided into two groups:femoral puncture(group=1)and carotid cut-down(CC,group=2).Results:Seventy-two catheterization procedures were performed in 64 patients;32(44.4%)were performed via the femoral approach and 40(55.6%)were performed via the carotid approach.Sixteen(22.2%)procedures were diagnostic and 56(77.8%)procedures were interventional.CC was performed in 13(32.5%)patients with failed femoral intervention.Patients in the CC group had shorter durations of procedure,vascular access,and anesthesia,compared with the femoral access group(80.9 and 116.2 min,p=0.001;12.9 and 22.5 min,p=0.001;140.9 and 166.6 min,p=0.001,respectively).Patients who underwent CC had fewer complications than did patients in the femoral access group(2.5%and 21.8%,respectively;p=0.01);larger sheats were used in CC patients(p=0.028).Conclusion:The carotid artery can be successfully used as a primary catheterization route,particularly in patients with small body weight and patients who require rapid vascular access,or stenting of the vertical duct.
基金Supported by Medical Science Research Project of Hebei Provincial Health Commission,No.20211642.
文摘BACKGROUND Carotid blowout syndrome(CBS)refers to rupture of the extracranial carotid artery and its branches;as a severe complication,it usually occurs after surgery or radiotherapy for malignant tumours of the head and neck.We present a case of CBS caused by chronic infection of the external carotid artery(ECA).In this case,we did not find any evidence of head and neck tumours.CASE SUMMARY A 42-year-old man was referred to the Emergency Department with a complaint of a lump found on the left side of his neck with pain and fever for 4 d.We diagnosed the condition as neck infection with abscess formation based on physical examination,routine blood examination,ultrasound examination and plain computed tomography(CT)and decided to perform emergency surgery.During the operation,30 mL of grey and smelly pus was drained from the deep surface of the sternocleidomastoid muscle.The second day after the operation,the patient suddenly exhibited a large amount of haemoptysis and incision bleeding.The enhanced CT showed distal occlusion of the left ECA and irregular thickening of the broken ends of the artery encased in an uneven enhancement of soft tissue density.Infected ECA occlusion and rupture were considered.The patient was transferred to a vascular unit for transcatheter ECA embolization and recovered well.CONCLUSION Surgeons need to pay attention to vascular lesions caused by chronic infection that may develop into acute CBS.
