Percutaneous dilatational tracheostomy (PDT) is preferred over conventional surgical tracheostomy for prolonged airway protection and mechanical ventilation.However, despite its advantages, severe PDT-related complications have been reported, including catastrophic hemorrhage from common carotid artery laceration and innominate TRIPHASIC SHAMPOO artery pseudo-aneurysm.PDT can typically be applied to the trachea, which is the focal point for the transverse course of great vessels (e.g., the anomalous brachiocephalic trunk, which overlaps with the targeted lesion anteriorly); KEGEL therefore, to improve patient outcomes, an alternative method using aortic debranching may be considered.