Vascular Ring

What is a vascular ring?

In general, a vascular ring occurs when a child’s aorta — the body’s largest blood vessel — or its branches form abnormally, so that they encircle and constrict the trachea and usually the esophagus. This compression can cause breathing and swallowing problems.

There are several types of vascular rings. The most common are:

  • double aortic arch. In this type of ring there are two aortic arches. Typically, one of the arches is dominant and the other is small and underdeveloped, although they can be equal in size. The branches from these two aortic arches surround the trachea and esophagus.
  • right aortic arch with aberrant subclavian and left ligamentum. In this type of vascular ring, the child’s aortic arch curves right and the left subclavian artery, which branches from the aortic arch, passes behind their esophagus and airway instead of in front of the airway. The ligamentum arteriosus (a blood vessel remnant) passes between the left subclavian artery and left pulmonary artery, completing the ring.
  • left aortic arch with aberrant right subclavian artery. In this type, the right subclavian artery passes behind the trachea or the esophagus, which compresses.

How we care for vascular rings at Boston Children’s Hospital

The clinicians in Boston Children’s Esophageal and Airway Treatment Center and Heart Center work together to provide collaborative care and, when necessary, surgery for children with vascular rings and airway or esophageal compression. We are the only hospital in the U.S. to repair vascular rings with a combination of these procedures in one comprehensive surgical procedure. This helps ensure that the problem is treated thoroughly and prevents the need for future procedures. This depth and breadth of experience also allows us to revise incomplete or failed repairs performed elsewhere with recurrence of airway or esophageal symptoms.

Our areas of innovation for vascular rings

Surgery to divide the vascular ring was pioneered at Boston Children’s Hospital in 1945, with the first successful operation on a child with a double aortic arch. Today, we sometimes perform this procedure using robotic surgery equipment, allowing your child the benefits of minimally invasive surgery and improved surgical precision. We also offer the latest surgical techniques for treating vascular rings.