title: Innominate artery transection for patients with severe chest deformity: optimal indication and timing.
abstract: OBJECTIVE
  The innominate artery sometimes compresses the trachea, leading to tracheomalacia and highly fatal tracheoinnominate fistula in patients with severe chest deformity. This study is focused on the indication of innominate artery transection for the definitive treatment of these complications.
  
  
  METHODS
  We retrospectively analyzed the medical records of eight patients who underwent transection of innominate artery.
  
  
  RESULTS
  All patients had developed severe chest deformity and their symptoms were life-threatening anoxic spell or endotracheal hemorrhage. Bronchoscopy showed tracheomalacia with or without pulsatile granulations on the anterior wall of the trachea underlying the innominate artery. In six cases who had previously undergone tracheostomy or laryngotracheal separation, the tracheal tube tip made granulations or tracheoinnominate fistulas. In addition to transection of innominate artery, the tracheoinnominate fistula was closed in two cases and the artery was transposed in one. All patients survived without neurologic complications and airway symptoms postoperatively.
  
  
  CONCLUSIONS
  For patients with severe chest deformity, innominate artery transection is indicated when they have tracheal compression by the artery and need to be intubated through the compressed part of trachea to secure the airway. This would be the best timing to schedule the prophylactic operation.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan. chsmt@med.kobe-u.ac.jp
authors.forename: Chieko
authors.initials: C
authors.lastname: Hisamatsu
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Okata
authors.forename: Azusa
authors.initials: A
authors.lastname: Zaima
authors.forename: Masao
authors.initials: M
authors.lastname: Yasufuku
authors.forename: Kosaku
authors.initials: K
authors.lastname: Maeda
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Okita
authors.forename: Eiji
authors.initials: E
authors.lastname: Nishijima
mesh_terms: D000293:Adolescent; D000328:Adult; D016122:Brachiocephalic Trunk / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005660:Funnel Chest / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D061646:Operative Time; D011859:Radiography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013905:Thoracoplasty / Q000379:methods*; D013997:Time Factors; D014135:Tracheal Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D055090:Tracheomalacia / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*; D055815:Young Adult