{"title":"Percutaneous dilatational tracheostomy in a patient with a large midline aberrant artery.","authors":"Balaji Vaithialingam, Abinash Dutta, Swaroop Gopal","doi":"10.1007/s12630-025-02942-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>A midline aberrant artery is an absolute contraindication to percutaneous dilatational tracheostomy (PDT). In this case report, we highlight a number of technical modifications that resulted in a successful PDT in a patient with a large midline aberrant artery.</p><p><strong>Clinical features: </strong>A 72-yr-old woman with a posterior cranial fossa hematoma underwent PDT due to prolonged mechanical ventilation in the neurointensive care unit. On clinical examination, the patient had a huge, pulsatile midline neck mass. Ultrasonography (US) showed an aberrant artery that covered the entire tracheal length and deviated to the right, away from the midline, just below the cricoid cartilage at the level of the first tracheal ring. The patient's family members were counseled, and following provision of informed consent, we planned PDT with technical modifications. After anesthesia induction, we replaced the endotracheal tube with a supraglottic airway device. We performed surface marking with US and chose a higher entry point between the first and second tracheal rings with a left anterolateral approach to the trachea. We made a 1-cm skin incision away from the midline towards the left side to aid with dilatation during the PDT procedure. We punctured the left anterolateral tracheal wall under real-time fibreoptic bronchoscopy and successfully performed PDT using a single-dilatation Ciaglia technique.</p><p><strong>Conclusion: </strong>This report provides an anecdotal description of successful PDT in a patient with a large midline aberrant artery based on the use of US and a number of technical modifications. Nevertheless, PDT should continue to be considered contraindicated in patients with a midline aberrant artery, in whom surgical tracheostomy is the recommended technique.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":"72 4","pages":"644-648"},"PeriodicalIF":3.4000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s12630-025-02942-2","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/4/12 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: A midline aberrant artery is an absolute contraindication to percutaneous dilatational tracheostomy (PDT). In this case report, we highlight a number of technical modifications that resulted in a successful PDT in a patient with a large midline aberrant artery.
Clinical features: A 72-yr-old woman with a posterior cranial fossa hematoma underwent PDT due to prolonged mechanical ventilation in the neurointensive care unit. On clinical examination, the patient had a huge, pulsatile midline neck mass. Ultrasonography (US) showed an aberrant artery that covered the entire tracheal length and deviated to the right, away from the midline, just below the cricoid cartilage at the level of the first tracheal ring. The patient's family members were counseled, and following provision of informed consent, we planned PDT with technical modifications. After anesthesia induction, we replaced the endotracheal tube with a supraglottic airway device. We performed surface marking with US and chose a higher entry point between the first and second tracheal rings with a left anterolateral approach to the trachea. We made a 1-cm skin incision away from the midline towards the left side to aid with dilatation during the PDT procedure. We punctured the left anterolateral tracheal wall under real-time fibreoptic bronchoscopy and successfully performed PDT using a single-dilatation Ciaglia technique.
Conclusion: This report provides an anecdotal description of successful PDT in a patient with a large midline aberrant artery based on the use of US and a number of technical modifications. Nevertheless, PDT should continue to be considered contraindicated in patients with a midline aberrant artery, in whom surgical tracheostomy is the recommended technique.
期刊介绍:
The Canadian Journal of Anesthesia (the Journal) is owned by the Canadian Anesthesiologists’
Society and is published by Springer Science + Business Media, LLM (New York). From the
first year of publication in 1954, the international exposure of the Journal has broadened
considerably, with articles now received from over 50 countries. The Journal is published
monthly, and has an impact Factor (mean journal citation frequency) of 2.127 (in 2012). Article
types consist of invited editorials, reports of original investigations (clinical and basic sciences
articles), case reports/case series, review articles, systematic reviews, accredited continuing
professional development (CPD) modules, and Letters to the Editor. The editorial content,
according to the mission statement, spans the fields of anesthesia, acute and chronic pain,
perioperative medicine and critical care. In addition, the Journal publishes practice guidelines
and standards articles relevant to clinicians. Articles are published either in English or in French,
according to the language of submission.