PDF(Pubmed)
Abstract：
UNASSIGNED: Innominate artery compression syndrome (IAS) is caused by an abnormally originating innominate artery compressing the trachea anteriorly. One option to relieve such compression is an anterior aortopexy (AA). We describe our technique of an AA via a partial upper median sternotomy.
UNASSIGNED: Nine consecutive patients underwent AA for IAS via a partial upper median sternotomy from July 2017 to November 2020 at two US teaching hospitals. The median age was 9 months [interquartile range (IQR), 3-16.5 months]. The male to female ratio was 1.25. All patients had >70% compression by flexible bronchoscopy. Two patients had previous surgeries. The median follow-up was 6 months (IQR, 4-8.5 months). The indications for the operation were: acute life-threatening events (ALTEs) (4/9 patients), recurrent intubation (4/9), and severe stridor with >70% luminal reduction (1/9). Technical success (defined as ≤20% residual stenosis) was achieved in 78% (7/9) of the patients. The two patients with unsuccessful AAs required either a tracheal resection or an innominate artery reimplantation. Both achieved full symptom resolution. Overall, 78% (7/9) of patients experienced full symptom resolution. Of the two patients without full symptom resolution, one had mild stridor at 6 months post-operation. The other patient without full resolution is awaiting further vocal cord surgery for an associated glottic pathology.
UNASSIGNED: A partial upper sternotomy provides a very versatile approach to an AA for IAS. In addition to facilitating an adequate AA, a partial upper sternotomy provides options for direct tracheal surgery or an innominate artery reimplantation in case an optimal result is not obtained by an AA.
UNASSIGNED: Nine consecutive patients underwent AA for IAS via a partial upper median sternotomy from July 2017 to November 2020 at two US teaching hospitals. The median age was 9 months [interquartile range (IQR), 3-16.5 months]. The male to female ratio was 1.25. All patients had >70% compression by flexible bronchoscopy. Two patients had previous surgeries. The median follow-up was 6 months (IQR, 4-8.5 months). The indications for the operation were: acute life-threatening events (ALTEs) (4/9 patients), recurrent intubation (4/9), and severe stridor with >70% luminal reduction (1/9). Technical success (defined as ≤20% residual stenosis) was achieved in 78% (7/9) of the patients. The two patients with unsuccessful AAs required either a tracheal resection or an innominate artery reimplantation. Both achieved full symptom resolution. Overall, 78% (7/9) of patients experienced full symptom resolution. Of the two patients without full symptom resolution, one had mild stridor at 6 months post-operation. The other patient without full resolution is awaiting further vocal cord surgery for an associated glottic pathology.
UNASSIGNED: A partial upper sternotomy provides a very versatile approach to an AA for IAS. In addition to facilitating an adequate AA, a partial upper sternotomy provides options for direct tracheal surgery or an innominate artery reimplantation in case an optimal result is not obtained by an AA.
摘要：
■无名动脉压迫综合征（IAS）是由异常起源的无名动脉压迫气管引起的。减轻这种压迫的一种选择是前主动脉固定术(AA)。我们描述了通过部分上正中胸骨切开术进行AA的技术。
从2017年7月至2020年11月，美国两家教学医院的9名连续患者通过胸骨上正中部分切开术接受了IASAA治疗。中位年龄为9个月[四分位距（IQR），3-16.5个月]。男女比例为1.25。通过柔性支气管镜检查所有患者均有>70%的压迫。两名患者以前做过手术。中位随访时间为6个月(IQR，4-8.5个月）。手术指征为：急性危及生命事件（ALTEs）（4/9例），反复插管（4/9），和严重喘鸣，管腔减少>70％（1/9）。78％（7/9）的患者获得了技术成功（定义为≤20％的残余狭窄）。两名AA失败的患者需要气管切除术或无名动脉再植。两者都实现了完全的症状解决。总的来说,78%(7/9)的患者经历了完整的症状消退。在没有完全症状解决的两名患者中，其中一人在术后6个月出现轻度喘鸣.另一名没有完全解决的患者正在等待进一步的声带手术，以进行相关的声门病理。
■胸骨上部分切开术为IAS的AA提供了一种非常通用的方法。除了促进足够的AA，在AA不能获得最佳结果的情况下，胸骨上部分切开术为直接气管手术或无名动脉再植入提供了选择。
从2017年7月至2020年11月，美国两家教学医院的9名连续患者通过胸骨上正中部分切开术接受了IASAA治疗。中位年龄为9个月[四分位距（IQR），3-16.5个月]。男女比例为1.25。通过柔性支气管镜检查所有患者均有>70%的压迫。两名患者以前做过手术。中位随访时间为6个月(IQR，4-8.5个月）。手术指征为：急性危及生命事件（ALTEs）（4/9例），反复插管（4/9），和严重喘鸣，管腔减少>70％（1/9）。78％（7/9）的患者获得了技术成功（定义为≤20％的残余狭窄）。两名AA失败的患者需要气管切除术或无名动脉再植。两者都实现了完全的症状解决。总的来说,78%(7/9)的患者经历了完整的症状消退。在没有完全症状解决的两名患者中，其中一人在术后6个月出现轻度喘鸣.另一名没有完全解决的患者正在等待进一步的声带手术，以进行相关的声门病理。
■胸骨上部分切开术为IAS的AA提供了一种非常通用的方法。除了促进足够的AA，在AA不能获得最佳结果的情况下，胸骨上部分切开术为直接气管手术或无名动脉再植入提供了选择。
