Clinical Fellow Cincinnati Children's Hospital Medical Center Cincinnati, Ohio
Extrinsic tracheal stenosis secondary to innominate artery compression is a rare cause of respiratory distress. Diagnosis is based on history, physical exam, cross-sectional imaging, and endoscopy. Presentation varies and can include respiratory distress, cyanosis, stridor, exercise intolerance, chronic cough, and reflex apnea. Treatments range from medical to surgical therapies, including thoracoscopic aortopexy. In patients with favorable anatomy, a cervical approach to innominate arteriopexy can be undertaken. This video highlights key landmarks and technique for cervical innominate arteriopexy. Key steps include skeletonizing the sternum and anterior mediastinum dissection with a partial thymectomy. The superior portion of the manubrium is resected to gain exposure to the innominate artery and vein. Mattress sutures are placed within the adventitia of the innominate artery and then through the sternum. Intraoperative bronchoscopy is performed to confirm anterior displacement of the tracheal wall.
Link to video: https://drive.google.com/file/d/1pvBbMvvZh9-x8hp0o1K03vaSZKV0IDZG/view?usp=sharing