Innominate artery compression syndrome, also known as brachiocephalic artery compression syndrome, is a rare cause of tracheal stenosis that occurs in the pediatric population.
The brachiocephalic artery usually takes its origin to the left of the trachea. The artery subsequently impinges on the trachea as it traverses anteriorly at the level of the thoracic inlet. Compression can be demonstrated on tracheography, CT, or MRI.
It should be noted that 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 diagnosis of innominate artery compression syndrome, therefore, requires the combination of 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, and the presence of obstructive symptoms.
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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