| Ultrasound mapping of soft tissue vascular anatomy proximal to the larynx: a prospective cohort study |
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Alessandro De Cassai1, Margherita Iuzzolino1, Silvia De Pinto1, Giovanni Zecchino1, Tommaso Pettenuzzo2, Annalisa Boscolo2,3,4, Eugenio Biamonte5, Paolo Navalesi2,3, Marina Munari1 |
1Sant’Antonio Anesthesia and Intensive Care Unit, University Hospital of Padova, Padova, Italy
2UOC Anesthesia and Intensive Care Unit, University Hospital of Padova, Padova, Italy
3Department of Medicine - DIMED, University of Padova, Padova, Italy
4Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Thoracic Surgery and Lung Transplant Unit, University of Padua, Italy
5Department of Medical and Surgical Sciences, Anesthesia and Intensive Care Unit, University Hospital R. Dulbecco, Magna Graecia University, Catanzaro, Italy |
Corresponding author:
Alessandro De Cassai, Tel: +390498216739,
Email: alessandro.decassai@gmail.com
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Received: 4 December 2023 • Revised: 23 April 2024 • Accepted: 23 April 2024 |
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| Abstract |
Background
Bleeding incidents during percutaneous dilatational tracheostomy are concerning, and most cases occur in patients with unrecognized and unanticipated anatomical variations in the vascular anatomy. However, the extent of this variation remains unclear. To address this knowledge gap, our study aimed to comprehensively map laryngeal vascular anatomy in a cohort of adult patients.
Methods
Ultrasound assessments of the soft tissue in the neck were performed, spanning from the thyroid cartilage to the third tracheal ring and extending 2 cm laterally on both sidesperformed. We subdivided this area into 12 zones comprising four medial and eight lateral sections. A pre-planned form was used to document the presence of arteries or veins in each zone. The results are reported as odds ratios, 95% CIs, and corresponding P-values.
Results
Five-hundred patients were enrolled from August 14, 2023, to November 13, 2023, at the University Hospital of Padua. Arteries and veins were identified in all investigated zones (varying from a minimum of 1.0%–46.4%). The presence of invessels progressively increased from the cricothyroid membrane to the third tracheal ring and from the midline to the paramedian laryngeal area.
Conclusions
Given the prevalence of arteries and veins, particularly in areas where tracheostomies are commonly performed, we strongly advocate for routine ultrasound assessments before such procedures are performed. |
| Key Words:
Bleeding; Complication; Mapping; Safety; Tracheostomy; Ultrasound |
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