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7歳男児の気管-腕頭動脈瘻に対し,腕頭動脈結紮術を行なった.腕頭動脈を結紮した際,術者が誤って左総頸動脈および左鎖骨下動脈をも同時に結紮した.左上肢に設置した観血的動脈圧モニターおよびパルスオキシメータの波形が消失したことから,左鎖骨下動脈の遮断に気づいた.さらに左総頸動脈が触知されないことから,左総頸動脈も結紮され,脳血流が完全に遮断されたことに気づいた.腕頭動脈結紮の際には,左総頸動脈からの血流が維持されているかを注意するべきである.そのためには,左総頸動脈の触診を続けること,左耳にパルスオキシメータを設置すること,および瞳孔の大きさを観察することなどが必要であると考えられた. A 7-year-old boy with tracheo-brachiocephalic artery fistula underwent ligation of the brachiocephalic artery. The left common carotid artery and subclavian artery were accidentally ligated together with the brachiocephalic artery during the procedure. Interruption of the left subclavian artery was found by disappearance of waves in the recordings of a pulse oximeter attached to the left middle finger and in the recordings of left radial artery pressure. Interruption of cerebral blood flow was found by loss of palpability of the left common carotid artery. Attention needs to be paid to the blood flow of the left common carotid artery in ligation of the brachiocephalic artery. It is necessary to palpate the left common carotid artery, set a pulse oximeter on the left ear and observe pupil size

A Case of Tracheo-brachiocephalic Artery Fistula: Accidental Interruption of Cerebral Blood Flow following Ligation of the Brachiocephalic Artery.