What evaluation criteria for prophylactic innominate artery transection were appropriate in the neurologically impaired patients who require laryngotracheal separation?

Purpose: This study aimed to analyze laryngotracheal separation (LTS) outcomes and evaluate the efficacy of the evaluation criteria for prophylactic innominate artery transection (PIAT) in neurologically impaired patients.

Methods: 67 patients who underwent LTS were reviewed. They were divided into three groups: patients without a tracheostomy tube (TT) (Group 1), patients with a TT but without PIAT (Group 2) and patients with TT and PIAT (Group 3). The length between the dorsal edge of the sternum and ventral edge of the vertebra (D-to-V), tracheal flattening ratio (TFR), and mediastinum-thoracic anteroposterior ratio (MTR), as evaluation criteria for PIAT based on the previous studies were measured.

Results: 62 patients [F/M = 25/37, Group 1 (n = 27), Group 2 (n = 29), and Group 3 (n = 6)] were analyzed. Three patients in Group 3 underwent PIAT after LTS due to intratracheal granuloma and minor bleeding. The TFR in Group 3 was significantly lower than that in Group 1 and 2 (p = 0.0236, 0.0054). The proportions of patients who met the criteria for PIAT were 5cases (8.06%) assessed by D-to-V, 21cases (33.87%) by TFR, and 37cases (59.68%) by MTR.

Conclusion: D-to-V would be the efficient criteria for PIAT and low TFR and MTR patients should be followed up carefully.