From
StayCurrentMD
QUAD #17 - Innominate Artery Compression and Management Through The Neck - Dr. Doug von Allmen
With CCHMC Pediatric Surgery · hosted by Dr. Brittany Levy
Part of
Tracheomalacia 12 items
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Innominate artery compression was initially described in the 1940s by Gross et al.
Innominate artery compression occurs in about 30% of children under 2 years old
Partial innominate artery compression can be seen commonly on routine bronchoscopies
Many patients with innominate artery compression are asymptomatic and do not need intervention
Intervention should be considered when innominate artery compression is associated with tracheomalacia or obstructive symptoms
Morbido et al. described a cervical approach to the innominate artery using a partial sternotomy
Yardley's group performed the procedure on 22 patients through a lower transverse cervical incision
Yardley's group achieved improvement in tracheal lumen of 35 to 80% in their series
Yardley's group saw improvement in symptoms in 72% of their patients
Syndromic patients had inferior outcomes with the cervical approach in Yardley's series
The case patient was a six-month-old with long gap esophageal atresia who had undergone a prior repair attempt with proximal pouch perforation and issues with TEF ligation
The case patient had a right-sided esophagostomy, right vocal cord paralysis, and required CPAP of 8
It is important to try not to dissect between the artery and the trachea during the procedure
The goal is to pull the artery forward and also drag the anterior tracheal wall forward
The cervical approach provides a good view of the anterior tracheal wall allowing placement of an anterior tracheopexy stitch if needed
Post-operative bronchoscopy showed improvement of the tracheal lumen in the case patient
The case patient was weaned off oxygen and discharged home on room air
At Cincinnati Children's Hospital, 2 out of 3 patients with tracheostomies were decannulated after the procedure
Some patients at Cincinnati Children's Hospital were discharged in 24 to 48 hours after the procedure
Patients with reduced room in the thoracic outlet may have inferior outcomes
Cincinnati Children's Hospital team found that patients with less than 1 centimeter of space between the innominate artery and the back of the sternum on CT had inferior results
Ideal candidates have the innominate artery positioned high and easy to access through the neck