Transection of the innominate artery for tracheomalacia caused by persistent opisthotonus

Abstract

Patients with cerebral palsy often develop opisthotonus. The trachea may be pinched between the innominate artery and the cervical spine. This compartmentalized thoracic inlet results in severe tracheomalacia. We successfully released tracheal compression by transection of the innominate artery. In case 1, a 4-year-old girl with cerebral palsy and opisthotonus was admitted due to respiratory distress. Bronchoscopy revealed severe tracheomalacia 2 cm above the carina. An endotracheal stent was placed through a tracheostomy. Two months later, she developed tracheal bleeding and bronchoscopy demonstrated a trachea-innominate artery fistula. Magnetic resonance brain angiography showed the presence of Willis' circle, and transection of the innominate artery was justified. This was done through a low cervical skin incision. In case 2, a 6-year-old boy with cerebral palsy and opisthotonus had long-standing respiratory distress. Ventilatory support did not resolve the symptoms. The innominate artery was transected in the same fashion as in the first case. Case 1 has been free from respiratory distress for 4 months and case 2 for 3 years. Our experience suggests that the combination of tracheomalacia, opisthotonus causes severe respiratory distress. Transection of the innominate artery is a useful therapeutic strategy to release airway obstruction in this condition.

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

“…Dividing the BCA for tracheomalacia also has been reported as a treatment option, but its long-term results have not been reported. 1 The frequency of complications by division or acute occlusion of the BCA is also unclear; however, some authors have noted that division or acute occlusion of the BCA could cause stroke, transient ischemic attack, and arm claudication. 5,6 A long endotracheal tube improved the tracheal stenosis in the current patient, but there was a risk of developing an arteriotracheal fi stula; therefore, she required some type of surgical procedure.…”

“…There are two basic approaches to relieving tracheal stenosis: endotracheal stenting and surgical intervention. 1 Surgical intervention includes aortopexy, aortotruncopexy, BCA suspension, reimplantation, and artifi cial tracheal implantation. Aortopexy or BCA suspension is the fi rst choice in tracheal stenosis via the BCA, based on the number of reports.…”

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

“…Transection of the innominate artery has been reported as useful in treating innominate artery compression of trachea in pediatric patients with neuromuscular disorders [3]. In adult patients, division or complicating postoperative stenosis of the innominate artery may produce hemodynamic and clinical lesions [6].…”

“…Alternative reimplantation of the innominate artery offers that a true anatomical relief [2], but carries the potential risks of bleeding, stroke, and stenosis at the anastomotic site. Transection of the innominate artery is a simple technique to release airway obstruction [3], but assumes integrity of the circle of Willis and could lead to subclavian steal syndrome. In our cases, the compressed segment of trachea by the innominate artery has been malacic and fragile, necessitating to be reinforced.…”

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

“…We previously introduced an operative technique to ameliorate tracheomalacia or tracheal compression caused by the innominate artery in neurologically impaired patients [1][2][3][4][5]. We applied this technique in six patients and found that it proved to be effective.…”