BRACHIOCEPHALIC (INNOMINATE) ARTERY COMPRESSION SYNDROME

Course overview

A VASCULAR RING, WHETHER COMPLETE OR INCOMPLETE, IS A FORM OF AORTIC ARCH MALFORMATION THAT CAN LEAD TO INNOMINATE ARTERY COMPRESSION SYNDROME (IACS). VASCULAR RINGS ARE ABNORMALITIES OF THE AORTIC ARCH THAT ENCIRCLE OR COMPRESS THE TRACHEA AND ESOPHAGUS. THE INCIDENCE OF IACS IS LOW, BUT IT CAN HAVE SEVERE CLINICAL CONSEQUENCES IF NOT RECOGNIZED AND TREATED APPROPRIATELY. THE PRESENTATION OF IACS CAN BE QUITE VARIABLE BUT TENDS TO MANIFEST IN THE PEDIATRIC POPULATION. SOME PATIENTS HAVE INTERMITTENT MILD RESPIRATORY SYMPTOMS (EG, DYSPNEA, WHEEZING, OR COUGH). OTHERS HAVE RECURRENT RESPIRATORY INFECTIONS AND CAN OFTEN BE MISDIAGNOSED. OCCASIONALLY, PATIENTS PRESENT IN SEVERE RESPIRATORY DISTRESS; IMAGING OR BRONCHOSCOPY MAKES THE DIAGNOSIS FAIRLY QUICKLY. SURGICAL INTERVENTION SHOULD BE CONSIDERED IN SYMPTOMATIC PATIENTS, WITH THE GOAL BEING TO RELIEVE TRACHEAL COMPRESSION. THOSE WITH MILD SYMPTOMS CAN OFTEN BE TREATED NONSURGICALLY WITH AGGRESSIVE AIRWAY CLEARANCE REGIMENS AND TREATMENT OF RESPIRATORY INFECTIONS, WITH SUPPLEMENTAL OXYGEN IF NECESSARY. THIS ACTIVITY FOR HEALTHCARE PROFESSIONALS IS DESIGNED TO ENHANCE THE LEARNER'S COMPETENCE IN RECOGNIZING INNOMINATE ARTERY COMPRESSION SYNDROME, PERFORMING THE RECOMMENDED EVALUATION, AND IMPLEMENTING AN APPROPRIATE INTERPROFESSIONAL MANAGEMENT APPROACH TO IMPROVE PATIENT OUTCOMES.