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J. Fredrik Grimmer, MD; Seth Herway, MS; John A. Hawkins, MD; Albert H. Park, MD; Peter C. Kouretas, MD, PhD

Arch Otolaryngol Head Neck Surg. 2009;135(1):80-84.

Objective  To evaluate the safety and long-term efficacy of innominate artery reimplantation as treatment for innominate artery compression syndrome.

Design  Retrospective medical record review from January 1, 1992, to December 31, 2007, and telephone interview.

Setting  Children's hospital.

Patients  Twenty-two children with innominate artery compression of the trachea requiring surgical intervention.

Intervention  Innominate artery reimplantation for innominate artery compression syndrome.

Main Outcome Measures  Respiratory symptoms, rigid bronchoscopy results, operative time, estimated blood loss, duration of hospitalization, and complications.

Results  Twenty-two patients were seen with innominate artery compression of the trachea causing respiratory distress. The diagnosis was made based on chest magnetic resonance images, computed tomographic angiograms, and rigid bronchoscopy results demonstrating significant (>75%) tracheal stenosis. Following innominate artery reimplantation, 19 patients (86%) had complete resolution of symptoms and discontinuation of respiratory support. Two patients had partial resolution, and 1 patient had no improvement. The time course of resolution was immediate in 13 patients, after 3 months in 1 patient, and unknown in 5 patients. The mean operative time was 73 minutes, with a mean estimated blood loss of 18 mL. The mean postoperative duration of hospitalization was 6.5 days, with a mode and median stay of 3 days. One patient required prolonged intubation (5 days), and another patient developed postpericardiotomy syndrome. Telephone interview of 10 patients at a mean of 5 years after surgery revealed continued resolution of respiratory symptoms if previously resolved and no long-term complications.

Conclusions  Innominate artery reimplantation is a safe and effective treatment for innominate artery compression syndrome. Resolution of symptoms occurs quickly in most patients, with excellent long-term results.

Author Affiliations: Divisions of Otolaryngology (Drs Grimmer and Park) and Cardiothoracic Surgery (Drs Hawkins and Kouretas), Department of Surgery, School of Medicine (Mr Herway), Primary Children's Medical Center, University of Utah, Salt Lake City.

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