Surgery or Surveillance? Outcomes of Symptomatic and Asymptomatic Patients With Vascular Rings

BACKGROUND AND OBJECTIVES Although patients with symptomatic vascular rings are typically referred for surgical relief, the management of patients who are asymptomatic remains controversial. We assessed outcomes of symptomatic and asymptomatic vascular rings managed over 14 years at our center, focusing on surgical and conservative approaches. METHODS This is a retrospective medical record review of 228 children diagnosed with vascular ring anomaly between January 2011 and December 2023. Data collected included anatomical subtypes, symptoms, diagnostics, management, and long-term outcomes. The primary outcome was symptom-free survival, with subgroup analyses for isolated vascular rings and comparisons by anatomical type. RESULTS Of the 228 patients, 177 had isolated vascular rings, most commonly right aortic arch (RAA) with aberrant left subclavian artery and double aortic arch (DAA). A total of 60% (n = 106) were symptomatic, and 83% of patients who were symptomatic underwent surgery, with symptom resolution in 77%. A total of 17% of patients who were symptomatic were managed conservatively, with 61% experiencing symptom improvement without surgery. Surgical outcomes were favorable, with low reintervention rates and no perioperative mortality, although persistent symptoms were observed in 20% of patients with RAA and 28% of patients with DAA. Age at surgery did not significantly affect symptom resolution in patients with RAA. A total of 40% of patients (n = 71) never developed symptoms. CONCLUSIONS Although surgical repair is effective, symptoms may persist in some cases. Patients who are asymptomatic can often be safely observed, with surgery reserved for those who develop symptoms. Multidisciplinary aerodigestive evaluations may help in guiding conservative management for select patients who are symptomatic.