Relationship between quantitative tracheal geometry and clinical course in various types of vascular ring

Abstract Purpose To investigate the relationship between quantitative tracheal geometry and clinical course among various types of vascular ring and to identify factors correlating with symptom presentation. Methods Patients with vascular ring diagnosed between April 2010 and December 2022 were included. All the patients were classified as type 1 (complete double aortic arch); type 2 (incomplete double aortic arch); type 3 (circumflex aorta); type 4 (right aortic arch and aberrant left subclavian artery with a left retroesophageal diverticulum of Kommerell); or type 5 (mirror-imaged right aortic arch with retroesophageal aortic diverticulum). Their clinical characteristics and quantitative variables on computed tomography (CT) imaging were compared. Results Of the 50 patients enrolled, type 1 tended to have a smaller luminal tracheal diameter at the level of the ring. The median symptom-free survival time was shortest in this group (16.0 days [95% confidence interval (CI): 9.4–51.0]), followed by type 3 (138.0 days [95% CI 0.0–851.4]). Type 1 (hazard ratio [HR]: 10.7; 95% CI: 1.8–23.9; P = 0.001), type 3 (HR: 4.5; 95% CI: 1.4–14.2; P = 0.011), and the percentage of tracheal narrowing in the anteroposterior projection (HR: 0.87; 95% CI: 0.79–0.97; P = 0.010) were significantly associated with symptom presentation in the time-dependent course. Conclusions Aortic arch encircling the entire circumference in type 1 and high-pressure vasculature in front of the vertebral body in types 1 and 3 may contribute to raising the risk of symptom presentation.