A new technique for treatment of tracheal compression by the innominate artery: external reinforcement with autologous cartilage graft and muscle flap suspension

Abstract

We report a new technique for treatment of tracheomalacia or tracheal compression caused by the innominate artery, utilized in two patients with neuromuscular disorders. Both cases developed a chest deformity in the setting of severe scoliosis. Computed chest tomography and fiberoptic bronchoscopy showed that the cervical trachea was compressed between the innominate artery and the cervical spine in the setting of deformity of the thoracic cavity. Both patients required prolonged mechanical ventilation prior to the operative procedure. To relieve compression by the innominate artery, the superior mediastinum was exposed by resection of part of the manubrium allowing a greater space, and external stenting of the cervical trachea with a reinforcing autologous cartilage graft and tracheopexy, as well as anterior suspension of the innominate artery with a sternohyoid muscle flap were carried out. Both patients were successfully weaned from prolonged mechanical ventilation. Resection of the manubrium sterni, tracheal stenting with rib segments and use of the strap muscle to elevate the innominate artery off of the trachea offer potential long-term release of airway obstruction.

Tracheal stenosis treated by division of the brachiocephalic artery: Report of a case

“…2 Reimplantation is not standard and carries the risk of early bleeding and stroke, as well as the potential for late stenosis at the anastomotic site. 3 Artifi cial tracheal implantation causes anastomotic stenosis, luminal stenosis, infection, dislocation, and migration.…”

“…Recently, a new technique for tracheal compression including reinforcement and suspension has been reported. 2 Although many articles have reported these treatments, the treatment strategy is not standardized because of the heterogeneity of these patients' conditions.…”

Tracheal suspension with autogenous rib cartilage in a patient with severe tracheomalacia

“…Compared with other scaffold materials like 3D-prints and bio-syntheses, rib cartilage is easier to be obtained and higher histocompatibility, and its transplant approach is more simple as well as less cost. Takekawa et al [6] reported two teenagers of severe chest deformity suffered from TM caused by innominate artery compression. Through autologous cartilage graft and muscle flap suspension,airway obstruction was obviously released.…”

Minimally invasive innominate artery transection for tracheomalacia using 3-dimensional multidetector-row computed tomographic angiography: report of a case

“…There are several surgical interventions for tracheomalacia owing to innominate artery compression, including transection, suspension and reimplantation of the innominate artery, and suspension and external reinforcement of the trachea [2,[9][10][11][12][13]. Tsugawa et al [2] indicated that transection of the innominate artery was useful in managing tracheomalacia owing to innominate artery compression caused by the anatomical relationships in pediatric patients with neuromuscular disorders.…”