Surgical strategy for acquired tracheomalacia due to innominate artery compression of the trachea

Abstract

We reviewed six cases demonstrating acquired tracheomalacia due to innominate artery compression of the trachea and investigated the benefit and effectiveness of a technique for correcting tracheomalacia. All the patients developed scoliosis and the innominate artery run over the trachea. Four cases had permanent neurologic impairment, whereas two patients developed acquired neurologic impairment. The surgical strategy for acquired tracheomalacia due to innominate artery compression of the trachea involved superior mediastinal exposure, external reinforcement with autologous cartilage graft, anterior sling of the innominate artery with a muscle sling, and tracheopexy. Our surgical procedure has been effective in maintaining the patency of the tracheal lumen in all cases but one. This patient suffered from straight back syndrome and developed recurrence of tracheomalacia owing to mucosal infolding secondary to the deformed spine in a supine position. The authors believe our surgical procedure is effective to relieve the symptoms of tracheomalacia, but it is important to select surgical interventions in accordance with the specific patient's condition.

Airway Obstruction Due to Tracheomalacia Caused by Innominate Artery Compression and a Kyphotic Cervical Spine

“…The anteriorly displaced vertebral column may not only reduce the anteroposterior diameter of the thorax but also cause membranous wall intrusion into the lumen of the airway with tracheal compression. Furthermore, tracheal compression with the innominate artery may be attributed to a narrowed sternospinal channel as the artery crosses the trachea, and on rare occasions, it is caused by a tortuous artery secondary to long-term hypertension, as seen in our case [4]. Consequently, both the kyphotic cervical spine and the innominate artery compression contributed to tracheal compression with TM in the present case.…”

“…Pulmonary theory states that air can come from the thoracic cavity through the retroperitoneum [3]. The extent of PI does not necessarily correlate with the severity of the symptoms or underlying disease [4]. Proven pneumatosis intestinalis in conjunction with a serum lactic acid level exceeding 2 mmol/L entails a high rate of fatal outcomes (>80%) [5].…”

“…Innominate artery reimplantation is a safe and effective treatment for innominate artery compression syndrome [4]. Airway stenting is appropriate only when surgical correction is not possible because of a higher possibility of failure or severe morbidity and mortality [8].…”

An Analysis of Tracheostomy Complications in Pediatric Patients With Scoliosis

“…Additionally, only 3.2% of patients were noted to have obstructive granulomas. Despite evidence in the literature of tracheal compression by the innominate artery or sternum in patients with scoliosis or neuromuscular disorders (Figure 2), 7,21,22 tracheal stenosis was only present in one patient, and vascular compression of the trachea was not noted in any patients. This may be due to lack of clear documentation differentiating between intrinsic tracheomalacia versus extrinsic compression.…”

“…Custom tracheostomy tubes are sometimes considered in patients with granulation tissue, tracheomalacia, or unique anatomy 13 ; in this population, 8.8% of patients required a custom-length tube for these issues. Because tracheal abnormalities, such as decreased size of the tracheal lumen, tracheal compression by the innominate arteries, or a tortuous trachea can be seen in patients with neuromuscular scoliosis, [6][7][8] the above complications are ostensibly due to the repeated contact of the tube or cuff against the trachea due to an inadequate conformation of the tube to the airway. Interestingly, however, poor positioning of the tracheostomy tube on tracheoscopy was noted only in 12.8% of patients.…”