Association of the truncus bicaroticus, common trunk of the left sub-sclavian and vertebral arteries, and retro-esophageal right subclavian artery. Case report

Truncus bicaroticus: an underestimated anatomic variation

OBJECTIVES/HYPOTHESIS

To illustrate that a truncus bicaroticus and an elongated truncus brachiocephalicus are underestimated anatomic variations; and to highlight the risk of injury of these vessel anomalies during routine surgical interventions.

DATA SOURCE

Report of a woman with long-term ventilation who was planned for conventional surgical tracheostomy. Due to a strong pulsatile vessel crossing the cricoid cartilage, the procedure was stopped. Further diagnostics revealed anomalies of the supraaortic vessels, including a truncus bicaroticus.

CONCLUSION

Anomalies of supraaortic vessels are not rare and injuries may cause severe bleeding; therefore, we recommend performing a preoperative ultrasound, particularly before starting dilatative tracheostomy.

Aortic arch aneurysm associated with arch vessel anomalies: truncus bicaroticus and retroesophageal right subclavian artery

An atherosclerotic aortic arch aneurysm associated with a common origin for both carotid arteries is a rare condition. An aberrant right subclavian artery is just as rare, especially with a retroesophageal course. A combination of these two conditions, we believe, has never been reported.

Truncus bicaroticus and an aberrant right subclavian artery contributing to internal jugular venous line misplacement into the carotid artery

Truncus bicaroticus, or common origin of the carotid arteries, is extremely rare and has been described sparsely in the literature. It has been reported as an incidental finding during cadaveric dissection and as an anatomic variant found during routine angiography. We report the case of a 75-year-old woman with a previously unknown truncus bicaroticus and an aberrant right subclavian artery in whom the anatomic variations contributed to an arterially placed central venous catheter remaining undetected. This catheter misplacement was suspected after the patient developed an embolic stroke, and subsequent studies demonstrated the truncus bicaroticus and intra-arterial catheter placement. To our knowledge, this is the first case reporting a truncus bicaroticus associated with an aberrant right subclavian artery.

Aberrant Right Subclavian Artery Associated with a Common Origin of Carotid Arteries

We present a patient with a rare anomaly of the aortic arch. Angiography revealed an aberrant right subclavian artery (aRSA) originating from the middle of the aortic arch. Angiography also demonstrated an anomalous origin of the left common carotid artery sharing a common trunk with the innominate artery and a large right vertebral artery arising from the right common carotid artery. Although this particular combination of anomalies has been reported in cadaver cases, to our knowledge this is the first premortem angiographic description of a patient in which an aRSA originates from the middle of the arch between the anomalous bovine arch trunk and the left subclavian trunk.