EN
TÜRKÇE
Oral Presentation - 35
Transcervical Innominate Artery Suspension in EA/TEF Patients
S Krishnapura, D von Allmen
Cincinnati Childrens
Introduction:
Tracheomalacia and vascular compression can cause significant obstructive symptoms in esophageal atresia and tracheoesophageal fistula (EA/TEF) patients. Innominate artery compression may be a focal area of compression that can be responsible for the severity of symptoms. In this case series, we aim to report the outcomes of a transcervical approach to innominate artery suspension in the EA/TEF population.
Methods:
Cases of transcervical innominate artery suspension at our institution with EA/TEF were reviewed. Computerized Tomography (CT) scans of the neck and chest were reviewed, and anterior-posterior thoracic outlet (TO) distance, thymic thickness, and sternum-innominate artery distance (SID) were measured. Surgical outcomes as verified by follow-up bronchoscopy and clinical course were obtained from the medical record. Success was defined as having both visual and symptomatic improvement in obstruction.
Results:
Eleven cases of transcervical innominate artery suspension were included in our review. This included nine female and two male patients, with an average age of 4.2 years (+/- 4.2). Eight patients (72%) showed improvement in their symptoms. The average anterior-posterior TO diameter was larger in patients with symptomatic improvement following innominate artery suspension than in those without improvement (38.19 mm vs. 28.63 mm, p-value 0.04, 95% CI 0.05 – 0.90). Age at the time of the surgery, operative time, thickness of the thymus, SID, and the ratio between SID and TO were all found to be non-significant factors impacting post-operative success. Three patients had complications including one death unrelated to surgery.
Conclusion:
Transcervical innominate artery suspension is effective for prominent anterior tracheal compression in EA/TEF patients. Success in this population closely mirrors that in the general population previously described by our group. A greater thoracic outlet diameter is associated with improvement in symptoms. Pre-operative CT evaluation is essential in surgical candidate selection.