Citation, DOI, disclosures and article data
Citation:
Sheikh Z, Sharma R, Elfeky M, et al. Innominate artery compression syndrome. Reference article, Radiopaedia.org (Accessed on 24 Apr 2024) https://doi.org/10.53347/rID-47451
Innominate artery compression syndrome, also known as brachiocephalic artery compression syndrome, is a rare cause of tracheal stenosis that occurs in the pediatric population. It is due to abnormal compression of the anterior aspect of the trachea as the brachiocephalic artery crosses it.
The diagnosis of innominate artery compression syndrome requires the combination of:
presence of obstructive symptoms
brachiocephalic artery origin to the left of the trachea
presence of tracheal narrowing on dynamic imaging or bronchoscopy at the level at which the brachiocephalic artery crosses
Diagnosis should be considered in children less than 3 years with stridor, breathing difficulties, asthma, apneic spells, and recurrent respiratory infections 6.
The brachiocephalic artery commonly takes its origin from the left of the trachea in normal children without obstructive symptoms or associated tracheal compression 5. The artery subsequently impinges on the trachea as it traverses anteriorly at the level of the thoracic inlet.
Tracheal compression by the brachiocephalic artery can be demonstrated on tracheography, CT, or MRI.
Treatment and prognosis
Authors have suggested surgical repair if tracheal luminal stenosis exceeds 70% in symptomatic patients. Surgical repairs usually involves aortopexy to fix the aortic arch and fixation of the innominate artery to the sternum.
As children grow the origin of the brachiocephalic artery gradually shifts rightward and so many children outgrow any tracheal impingement.
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1. Schuster T, Hecker W, Ring-Mrozik E, Mantel K, Vogl T. Tracheal Stenosis by Innominate Artery Compression in Infants: Surgical Treatment in 35 Cases. Prog Pediatr Surg. 1991;:231-43. doi:10.1007/978-3-642-87767-4_13
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2. Hennington M, Detterbeck F, Molina P, Wood R. Innominate Artery and Tracheal Compression Due to Aberrant Position of the Thymus. Ann Thorac Surg. 1995;59(2):526-8. doi:10.1016/0003-4975(94)00529-g
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3. Myer C, Auringer S, Wiatrak B, Bisset G. Magnetic Resonance Imaging in the Diagnosis of Innominate Artery Compression of the Trachea. Arch Otolaryngol Head Neck Surg. 1990;116(3):314-6. doi:10.1001/archotol.1990.01870030078013 - Pubmed
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4. Hawkins JA, Bailey WW, Clark SM. Innominate artery compression of the trachea. Treatment by reimplantation of the innominate artery. J. Thorac. Cardiovasc. Surg. 1992;103 (4): 678-82. Pubmed citation
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5. Fawcett SL, Gomez AC, Hughes JA et-al. Anatomical variation in the position of the brachiocephalic trunk (innominate artery) with respect to the trachea: a computed tomography-based study and literature review of Innominate Artery Compression Syndrome. Clin Anat. 2009;23 (1): 61-9. doi:10.1002/ca.20884 - Pubmed citation
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6. Koivikko A, Puhakka H, Vilkki P. Innominate Artery Compression Syndrome. ORL. 1976;38(3):187-92. doi:10.1159/000275274 - Pubmed
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7. Bryce A. Dugas & Navdeep S. Samra. Anatomy, Thorax, Brachocephalic (Right Innominate) Arteries. StatPearls Publishing. 2022. https://www.ncbi.nlm.nih.gov/books/NBK557678/ - Pubmed
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