Prophylactic innominate artery transection to prevent tracheoinnominate artery fistula: a retrospective review of single institution experiences
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In brief
In brief
This retrospective study evaluates prophylactic innominate artery transection in 13 patients with neuromuscular disorders at risk for tracheoinnominate fistula. The procedure proved safe with no neurological complications, and two novel CT imaging ratios (TFR and MTR) successfully identified appropriate surgical candidates.
Written by the GCMD Library team from the article.
Abstract
Purpose
This study aimed to investigate the optimal indication and availability of prophylactic innominate artery transection (PIAT).
Methods
We retrospectively analyzed the medical records of the patients with neurological or neuromuscular disorders (NMDs) who underwent PIAT. Meanwhile, we originally defined the tracheal flatting ratio (TFR) and mediastinum–thoracic anteroposterior ratio (MTR) from preoperative chest computed tomography imaging and compared these parameters between non-PIAT and PIAT group.
Results
There were 13 patients who underwent PIAT. The median age was 22 years. PIAT was planned before in one, simultaneously in five, and after tracheostomy or laryngotracheal separation in seven patients. Image evaluations of the brain to assess circle of Willis were performed in all patients. Appropriate skin incisions with sternotomy to expose the innominate artery were made in four patients. All patients are still alive except one late death without any association with PIAT. No neurological complications occurred in any patients. As significant differences (p < 0.01) between two groups were observed for TFR and MTR, objective validity of the indication of PIAT was found.
Conclusions
PIAT is safe and tolerable in case of innominate artery compression of the trachea with NMDs. TFR and MTR are useful objective indexes to judge the indication of PIAT.