Related Experiment Video
Updated: Aug 17, 2026
Scaling of Engineered Vascular Grafts Using 3D Printed Guides and the Ring Stacking Method
Published on: March 27, 2017
Trends in vascular ring surgery
Carl L Backer1, Constantine Mavroudis, Cynthia K Rigsby
1Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill, USA. cbacker@childrensmemorial.org
Insights
Vascular ring diagnosis has shifted to CT/MRI, with surgical outcomes improving due to minimally invasive techniques. Recommendations include preoperative bronchoscopy and echocardiography for better patient care.
Area of Science:
- Cardiology
- Pediatric Surgery
- Diagnostic Imaging
Background:
- Vascular rings are congenital anomalies affecting the aorta and pulmonary arteries.
- Anatomically complete vascular rings include double aortic arch and right aortic arch with left ligamentum.
- Surgical repair is necessary for symptomatic patients.
Purpose of the Study:
- To review experience with infants and children with anatomically complete vascular rings.
- To define perioperative trends in diagnostic imaging, operative techniques, and clinical outcomes.
- To evaluate changes in management and outcomes over time.
Main Methods:
- Retrospective review of 209 patients (1946-2003) with double aortic arch or right aortic arch.
- Analysis of diagnostic imaging modalities, surgical approaches, and patient outcomes.
- Comparison of trends in diagnosis and treatment over different time periods.
Main Results:
- No operative mortality since 1959.
- Shift in diagnostic imaging from barium swallow/angiography to CT/MRI.
- Decreased mean hospital stay from 8 to 3 days with muscle-sparing thoracotomy.
- Increased use of preoperative/intraoperative bronchoscopy (73% in the last 10 years).
- Successful resection of Kommerell diverticulum with left subclavian artery transfer in 7 recent patients.
Conclusions:
- Computed tomographic scanning is the preferred diagnostic tool for vascular rings.
- Preoperative bronchoscopy and echocardiography are recommended.
- Muscle-sparing thoracotomy without routine chest drainage reduces hospital stay.
- Diverticulum resection with left subclavian artery transfer is effective for right aortic arch with Kommerell diverticulum.
Objective:
We sought to review our experience with infants and children with anatomically complete vascular rings (ie, double aortic arch and right aortic arch with left ligamentum) and define perioperative trends in diagnostic imaging, operative techniques, and clinical outcomes.
Methods:
From 1946 through 2003, 209 patients (113 with double aortic arch and 96 with right aortic arch) underwent surgical repair. Mean and median ages at the time of the operation were as follows: double aortic arch, 1.4 +/- 2.4 years and 0.75 years, respectively; right aortic arch, 2.7 +/- 3.9 years and 0.9 years, respectively. Fourteen (14.6%) patients with right aortic arch had an associated Kommerell diverticulum. Cardiac diagnoses were present in 26 (12.4%) of 209 patients.
Results:
There has been no operative mortality since 1959. In the past 30 years, mean hospital stay decreased from 8 to 3 days. Primary means of diagnosis has shifted from barium swallow and angiography to computed tomographic scanning or magnetic resonance imaging. In the past 10 years, 73% of patients had preoperative or intraoperative bronchoscopy. The technique of operation has shifted to a muscle-sparing left thoracotomy without routine chest drainage. In 7 recent patients with right aortic arch and a Kommerell diverticulum, the diverticulum was resected, and the left subclavian artery was transferred to the left carotid artery as a primary procedure.
Conclusions:
At our institution, computed tomographic scanning has replaced barium swallow as the diagnostic procedure of choice for vascular ring evaluation. We recommend both preoperative bronchoscopy and echocardiography. Use of a muscle-sparing thoracotomy without routine chest drainage has decreased mean hospital stay. For patients with a right aortic arch and associated Kommerell diverticulum, we recommend diverticulum resection with left subclavian artery transfer to the left carotid artery.
