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Anatomy of the head and neck
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
The common carotid arteries are both branches of the brachiocephalic artery on the right and aortic arch on the left. They are enclosed within the tough protective fibrous carotid sheath that also encloses the internal jugular vein and vagus nerve to the posterior of the artery, and which lies lateral to the trachea and oesophagus. Both right and left common carotid arteries terminate at the level of the upper border of the thyroid cartilage, bifurcating to give rise to internal and external carotid arteries. A swelling at the division of the artery is the location of the carotid sinus and carotid body containing chemo- and baroreceptors.
Cardiovascular system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
The thoracic aorta commences at the aortic valve and passes into the abdomen by passing through the diaphragmatic hiatus at the level of the T12 vertebral body. It is divided into the ascending aorta, aortic arch and descending aorta. Major vessels arise from the ascending aorta and arch. The right and left coronary arteries arise from the root of the ascending aorta close to the aortic valve cusps. The aortic arch gives rise to three large vessels that supply the head and neck region and the upper limbs: the brachiocephalic artery (also known as the brachiocephalic trunk or innominate artery), the left common carotid artery and the left subclavian artery. The brachiocephalic artery divides and give rise to the right common carotid and right subclavian arteries. Each common carotid artery divides into the internal and external carotid arteries. The vertebral artery arises as the first branch of the subclavian artery on each side. The subclavian artery passes laterally to continue as the axillary artery at the lateral border of the first rib. The axillary artery continues down the arm and at the inferior margin of the teres major muscle it becomes the brachial artery. At the cubital fossa the brachial artery divides into the radial and ulnar arteries, which continue down the forearm to the hand.
Thyroid Microcirculation
Published in John H. Barker, Gary L. Anderson, Michael D. Menger, Clinically Applied Microcirculation Research, 2019
Linda J. Huffman, George A. Hedge
Each thyroid lobe is supplied by arterial blood from two primary sources.1,2 A superior thyroid artery, arising principally from the external carotid artery, supplies blood to the rostral area of the thyroid lobe. An inferior thyroid artery, deriving most often from the thyrocervical trunk, supplies blood to the caudal areas of the thyroid lobe. In addition to these bilateral arterial inputs to the thyroid, a thyroid ima artery may be located anterior to the trachea and, when present, provides blood to the inferior portion of the gland. This accessory artery appears to arise most often from the brachiocephalic artery, the right common carotid artery, or the aortic arch. Significant anastomoses among the arterial inputs to the thyroid gland occur, with the superior thyroid artery uniting with the contralateral artery in the isthmus area and with the inferior thyroid artery on the posterior and anterior surface of the thyroid gland. Anastomoses between thyroid arteries and the tracheal arterial supply (e.g., inferior laryngeal artery and tracheoesophageal artery) also exist.
Current Evidence for Alternative Access Transcatheter Aortic Valve Replacement
Published in Structural Heart, 2020
J. James Edelman, Chistopher Meduri, Pradeep Yadav, Vinod H. Thourani
Transaxillary/subclavian access accounted for 34% of alternative access procedures with the S3 valve in the STS/ACC TVT Registry; this increased from 20% in 2015 to 49% in the final quarter of 2017.14 Correspondingly, there was a significant decrease in TA access in this time. In a propensity-matched analysis, mortality was lower in TAx compared with TA (5.3% vs. 8.4%, p < 0.01), but stroke was significantly higher (6.3% vs. 3.1%, p < 0.05).14 Outcomes of TAx were similar to TF access in a propensity-matched cohort of the Corevalve Pivotal and Continued Access trials, which included patients at extreme- or high-risk for aortic valve surgery.15 Mortality at 30 days was similar; an increased rate of stroke (6.5% vs. 3.5%, p = 0.165) in the TAx arm did not achieve statistical significance. Brachiocephalic artery access, either via suprasternal incision or upper hemi-sternotomy has been described in several series, with good results16–19; but has not gained widespread adoption.
Acute Aortic Dissection in Young Adult Patients: Clinical Characteristics, Management, and Perioperative Outcomes
Published in Journal of Investigative Surgery, 2020
Shuai Zhu, Tie Zheng, Zhi-Yu Qiao, Li Chen, Jia-Fu Ou, Wei-Gang Fang, Cheng-Nan Li, Lei Chen, Wei-Guo Ma, Jun Zheng, Yong-Min Liu, Li-Zhong Sun, Xue-Jun Sun, Jun-Ming Zhu
ECG, echocardiogram and CT data of 489 of 490 patients were retrieved from medical records for analysis (Table 2). There were totally 244 ECG cases available. Out of these data 61 cases were normal and 168 cases displayed new Q-wave, ST elevation/reduction, or bidirectional/inverted T waves. There were 210 aortic and 123 mitral regurgitation cases. In both groups of regurgitation, the majority was classified as mild (aortic regurgitation, 105/210 cases; mitral regurgitation, 107/123). For CT findings (n = 486), the number of type A and B were 310 (63.78%) and 176 (36.22%), respectively. There were totally 478 cases with findings on diagnostic imaging available. Involvement of brachiocephalic artery (n = 196), left common carotid artery (n = 176), and left subclavian artery (n = 207) could be seen. Number of aortic intramural and aortic hematoma was 87 and 79, respectively.
Major vessel invasion by thyroid cancer: a comprehensive review
Published in Expert Review of Anticancer Therapy, 2019
Michael S. Xu, Jennifer Li, Sam M. Wiseman
Arterial invasion by thyroid cancer is less commonly reported than venous invasion. The pattern of arterial involvement by thyroid cancer tends to be extraluminal encasement/abutment of the local arterial system, as opposed to the development of an intraluminal tumor thrombus. The most commonly affected arteries are the CAs [25,49,70,71], although there have also been isolated reports of aortic arch [71] and subclavian artery [70] invasion. Several, reported cases of arterial invasion by thyroid cancer are notable. Nomori et al. [49] reported on a case of locally advanced PTC that presented with concurrent invasion of the trachea and brachiocephalic artery, both of which were surgically resected. The brachiocephalic artery was reconstructed using a synthetic graft, while the tracheal resection defect was reconstructed with an end-to-end tracheal anastomosis. Korkmaz et al. [72] reported on a case of PTC with invasion into the left carotid bifurcation that masqueraded as a carotid body tumor. Bhargav et al. [71] reported a single case of stage IVB ATC with extensive CA and tracheal encasement that extended to the level of the aortic arch, and was resected. However, the patient’s postoperative outcome was not reported. A case series reported by Brown and Ducic described four ATC patients with encasement of the CA by thyroid cancer. The four patients were palliated non-surgically, and had an average survival of 3.8 months [73].