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Prophylactic innominate artery transection to prevent tracheoinnominate artery fistula: a retrospective review of single institution experiences

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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.

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References

  1. Hasegawa T, Oshima Y, Hisamatsu C, Matsuhisa H, Maruo A, Yokoi A, Bitoh Y, Nishijima E, Okita Y (2014) Innominate artery compression of the trachea in patients with neurological or neuromuscular disorders. Eur J Cardiothorac Surg 45:305–311

    Article  Google Scholar 

  2. Hisamatsu C, Okata Y, Zaima A, Yasufuku M, Maeda K, Okita Y, Nishijima E (2012) Innominate artery transection for patients with severe chest deformity: optimal indication and timing. Pediatr Surg Int 28:877–881

    Article  Google Scholar 

  3. Sato H, Kawase H, Furuta S, Shima H, Wakisaka M, Kitagawa H (2012) Tracheoinnominate artery fistula after laryngotracheal separation: prevention and management. J Pediatr Surg 47:341–346

    Article  Google Scholar 

  4. Monnier P (2011) Tracheomalacia. In: Monnier P (ed) Pediatric airway surgery, 1st den. Springer, Heidelberg, pp 159–167

    Chapter  Google Scholar 

  5. Allan JS, Wright CD (2003) Trachioinnominate fistula: diagnosis and management. Chest Surg Clin N Am 13:331–341

    Article  Google Scholar 

  6. Jones JW, Reynolds M, Hewitt RL, Drapanas T (1976) Tracheo-innominate artery erosion: Successful surgical management of a devastating complication. Ann Surg 184:194–204

    Article  CAS  Google Scholar 

  7. Wood DE, Mathisen DJ (1991) Late complications of tracheotomy. Clin Chest Med 12:597–609

    CAS  PubMed  Google Scholar 

  8. Olson MD, Boesch RP, Duncan AA, Cofer SA (2016) Avoidance of a potential tracheoinnominate fistula by innominate artery re-implantation in a four year old girl with tracheostomy dependence and Pfeiffer syndrome. Int J Pediatr Otorhinolaryngol 81:97–99

    Article  Google Scholar 

  9. Schaefer OP, Irwin RS (1995) Tracheoarterial fistula : an unusual complication of tracheostomy. J Intensive Care Med 10:64–75

    Article  CAS  Google Scholar 

  10. Nelems JM (1981) Tracheo-innominate artery fistula. Am J Surg 141:526–527

    Article  CAS  Google Scholar 

  11. Fukumoto K, Urushihara N, Fukuzawa H, Sugiyama A, Nagae H, Watanabe K, Mitsunaga M, Akazawa S, Hasegawa S (2011) Laryngotracheal separation using skin flap formation: a novel surgical procedure. Pediatr Surg Int 27:67–71

    Article  Google Scholar 

  12. Ridley RW, Zwischenberger JB (2006) Tracheoinnominate fistula: surgical management of an iatrogenic disaster. J Laryngol Otol 120:676–680

    Article  CAS  Google Scholar 

  13. Tsugawa C, Ono Y, Nishijima E, Takamizawa S, Satoh S, Muraji T (2004) Transection of the innominate artery for tracheomalacia caused by persistent opisthotonos. Pediatr Surg Int 20:55–57

    Article  Google Scholar 

  14. Takekawa Y, Muraji T (2011) Surgical strategy for acquired tracheomalacia due to innominate artery compression of the trachea. Eur J Cardiothorac Surg 39:412–413

    Article  Google Scholar 

  15. Takahashi K, Enatsu K, Nakayama M, Uchida T, Takahashi H (2005) A case with trachea-innominate artery fistula. Successful management of endovascular embolization of innominate artery. Auris Nasus Larynx 32:195–198

    Article  Google Scholar 

  16. Joshi AS, Tanna N, Elmaraghy CA, Obokhare I, Ponsky TA, Pena MT, Slack MC (2007) Nonsurgical treatment of tracheoinnominate fistula in the pediatric population. Arch Otolaryngol Head Neck Surg 133:294–296

    Article  Google Scholar 

  17. Kapoor K, Singh B, Dewan LI (2008) Variations in the configuration of the circle of Willis. Anat Sci Int 83:96–106

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatric Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Kan Suzuki, Jun Fujishiro, Chizue Ichijo, Eiichiro Watanabe, Kotaro Tomonaga, Tomohiro Sunouchi & Yasuo Watanabe

Authors
  1. Kan Suzuki
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  2. Jun Fujishiro
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  3. Chizue Ichijo
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  4. Eiichiro Watanabe
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  5. Kotaro Tomonaga
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  6. Tomohiro Sunouchi
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  7. Yasuo Watanabe
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Correspondence to Kan Suzuki.

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Conflict of interest

The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

Ethical approval

This study was performed with the approval of the institutional review board in our institution (approval number 2996), and the need for individual consent was waived.

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Suzuki, K., Fujishiro, J., Ichijo, C. et al. Prophylactic innominate artery transection to prevent tracheoinnominate artery fistula: a retrospective review of single institution experiences. Pediatr Surg Int 37, 267–273 (2021). https://doi.org/10.1007/s00383-020-04792-z

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  • DOI: https://doi.org/10.1007/s00383-020-04792-z

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