Challenging Tracheostomy - A Novel Approach in a Rare Anomaly of the Brachiocephalic Artery

A 70 year old post craniotomy patient on ventilator required tracheostomy for early weaning. An anomalous Brachiocephalic trunk running across the surgical site was making the surgery challenging due to difficulty during surgery and also post operative risk of torrential bleeding due to injury to the vessel by the tracheostomy tube causing vascular rupture.