Anatomical variations of brachiocephalic artery among cadaveric population of Uganda and their implications on tracheostomy procedures
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Date
2023-05
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Kampala International University
Abstract
The Brachiocephalic artery (BCA) expresses several anatomical variations in different populations, most of which are associated with variations in an aortic arch branching pattern. The variations in origin, branching pattern and the course of the Brachiocephalic artery in relation to the trachea and thyroid gland have profound surgical importance because any alteration in the ordinary course of the Brachiocephalic artery increases the possibility of accidental injury during emergency Tracheostomy or thyroid surgeries which may lead to a haemorrhage that is fatal to the patient. The study was done to examine variations in morphology and morphometry of the Brachiocephalic artery and their clinical implications. Fifty-eight (58) adult cadavers, 57 males and 1 female were dissected to expose the Brachiocephalic artery and the morphological and morphometric variations were recorded. Fifty-one (51) cadavers (87.6%) had the Brachiocephalic artery arising directly from the aortic arch while 7 cadavers (12.4%) had the artery originating from the common trunk with the left common carotid artery. In relation to the trachea, the BCA arose on the left anterolateral to the trachea in 57 cadavers (98.3%) and in one female cadaver (1.7%), the artery arose in the midline anterior to the trachea and ascended to terminate at the posterior surface of right sternoclavicular joint where it bifurcated into right subclavian and right common carotid artery in all 58 cadavers. The mean torso length of cadavers was found to be 45.78±2.93cm and the mean length of Brachiocephalic artery was found to be 4.14±0.58cm. A statistically significant positive correlation was found between cadaveric torso length and BCA length (r=0.33, p<0.05,) which implies that individuals with longer torsos may have longer BCA. In majority of the population in Uganda, the Brachiocephalic artery has a normal origin, course and branching pattern. Occurrence of origin variant of BCA from common trunk may be associated with tracheal compression, aortic dialation and it should be considered as a potential risk factor for thoracic aortic aneurysm. Also, the observed origin of BCA in the midline anterior to trachea can increases chances of accidental to the artery during Tracheostomy and should be taken into consideration during pre-operative planning for Tracheostomy. The observed relationship between torso length and BCA can used for estimation of BCA length for BCA catheterization. Similar studies in living individuals using MRI and angiography is recommended to enable the comparison of cadaveric and living human data.
Description
A dissertation submitted in partial fulfillment of the requirements for the award of the degree of Masters of Science in Human Anatomy of Kampala International University