Vascular Rings

Abstract

In this chapter only those vascular anomalies are discussed that cause symp toms of tracheal and/or esophageal compression. Th’se vascular anomalies have all one common characteristiC., i.e. they form a complete vascular ring around the trachea and/or the esophagus. For a more complete review the reader is referred to the excellent monograph „Esophagography in anomalies of the aortic arch system“ (Klinkhamer, 1969). The main feature of a congenital vascular ring is that the esophagus and trachea no longer occupy their normal retrovascular position but are encircled to a greater or lesser degree by anomalous vascular structures. The embryologic development of the aorta and its branches permits a great variety of possible anomalies (Edwards, 1948; Blake and Manion, 1962). Thèse aberrant arteries in the upper mediastinum assume importance when they compress the trachea or the esophagus or both. The clinical signs of this compression are not characteristic of any particular type of anomaly; these malformations can all produce similar symptoms. In general they manifest themselves in two age groups: in the first years of life if the ring around the trachea and esophagus is so narrow that compression becomes apparent very soon, and in the elderly if the ring, which was initially too wide to cause compression, begins to narrow and becomes rigid as a result of arteriosclerotic changes and reduced elasticity of the vascular wall.