VASCULAR COMPRESSION OF THE AIRWAY - INDICATIONS FOR AND RESULTS OF SURGICAL-MANAGEMENT

Vascular compression of the airway is a significant cause of respirato ry compromise in children. While the indications for surgical repair a re sometimes life threatening, they can also be subtle. This retrospec tive study examines 45 surgical cases of tracheobronchial compromise s econdary to vascular compression at a large children's hospital betwee n July 1983 and February 1996. A total of 34 were diagnosed with innom inate artery compression, ten with a double aortic arch and one with a n anomalous right subclavian artery. The 45 patients, 25 male and 20 f emale, ranged in age from 12 days to 11 years at surgery (average 13 m onths). A total of 21 (47%) presented with proven or suspected episode s of cyanosis or apnea. All 45 patients had evidence of vascular compr ession during microlaryngoscopy and bronchoscopy. The diagnosis was co nfirmed by magnetic resonance imaging (MRI) in 23/45 (51%), barium swa llow in 22/45 (49%) and aortogram in 3/45 (7%). There was one death. O ne patient had a tracheotomy before surgery and continues to require i t after surgery. Complete resolution of symptoms was achieved in 39/45 (87%) with five requiring more than one operation before their sympto ms resolved completely. A total of four patients experienced a recurre nce of symptoms within a variable length of time after surgery. Surgic al indications and treatment alternatives will be discussed. (C) 1997 Elsevier Science Ireland Ltd.