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Prevalence and Complications of Aberrant Subclavian Artery in Patients With Heritable and Nonheritable Arteriopathies. J Am Coll Cardiol 2023; 81:979-991. [PMID: 36889877 DOI: 10.1016/j.jacc.2023.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/27/2022] [Accepted: 01/03/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND An aberrant subclavian artery (ASA) (or lusoria) is the most common congenital anomaly of the aortic arch (0.5%-2.2%; female-to-male ratio 2:1 to 3:1). ASA can become aneurysmal and result in dissection, involving Kommerell's diverticulum when present and the aorta. Data of its significance in genetic arteriopathies are not available. OBJECTIVES The purpose of this study was to assess the prevalence and complications of ASA in gene-positive and -negative nonatherosclerotic arteriopathies. MATERIALS The series includes 1,418 consecutive patients with gene-positive (n = 854) and gene-negative arteriopathies (n = 564) diagnosed as part of institutional work-up for nonatherosclerotic syndromic and nonsyndromic arteriopathies. Comprehensive evaluation includes genetic counseling, next-generation sequencing multigene testing, cardiovascular and multidisciplinary assessment, and whole-body computed tomography angiography. RESULTS ASA was found in 34 of 1,418 cases (2.4%), with a similar prevalence in gene-positive (n = 21 of 854, 2.5%) and gene-negative (n = 13 of 564, 2.3%) arteriopathies. Of the former 21 patients, 14 had Marfan syndrome, 5 had Loeys-Dietz syndrome, 1 had type-IV Ehlers-Danlos syndrome, and 1 had periventricular heterotopia type 1. ASA did not segregate with genetic defects. Dissection occurred in 5 of 21 patients with genetic arteriopathies (23.8%; 2 Marfan syndrome and 3 Loeys-Dietz syndrome), all with associated Kommerell's diverticulum. No dissections occurred in gene-negative patients. At baseline, none of the 5 patients with ASA dissection fulfilled criteria for elective repair according to guidelines. CONCLUSIONS The risk of complications of ASA is higher in patients with genetic arteriopathies and is difficult to predict. In these diseases, imaging of the supra-aortic trunks should enter baseline investigations. Determination of precise indications for repair can prevent unexpected acute events such as those described.
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Requejo-Garcia L, Martinez-Lopez R, Plana-Andani E, Medina P, Hernandiz-Martinez A, Miralles-Hernández M. Extra-Thoracic Aneurysms in Marfan Syndrome: A Systematic Review of the Literature. Ann Vasc Surg 2022; 87:548-559. [PMID: 36029951 DOI: 10.1016/j.avsg.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/31/2022] [Accepted: 08/07/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Marfan syndrome (MS) most often shows as thoracic aortic aneurysm (TAA) or aortic dissection, but it may also involve other vascular territories. OBJECTIVE To identify those extra-thoracic vascular manifestations most frequently associated with MS. METHODOLOGY Systematic review of the literature with PRISMA criteria. The following databases were included: Medline, Embase, Web of Science (WOS), Cumulative Index of Nursing and Health Sciences Literature (CINHAL); Spanish database MEDESY Cochrane Central Register of Controlled Trials (CENTRAL). RESULTS 10,008 articles were identified, leaving 155 for the first stage of data analysis (total incidence of aneurysms) and 83 for the second (descriptive data analysis). Overall, 518 aneurysms were identified: 149 in the head and neck, 94 in the extremities 275 in the aortic, iliac and visceral sectors. Mostly, they were simultaneously discovered during studies of the AAT. In the abdominal aorta, the presentation with rupture in 11 of 32 patients stands out. Resection and bypass was the most frequently used method for repair in the treated cases. CONCLUSIONS Although its frequency in the general population is unknown, this systematic review suggests that extra-thoracic aneurysmal arterial involvement in the MS may be more frequent than expected. We believe screening for aneurysms in other vascular sectors may be advisable, especially in patients with MS and AAT.
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Affiliation(s)
- L Requejo-Garcia
- Angiology and Vascular Surgery Department. Hospital Universitario de La Ribera, Alzira, Valencia
| | - R Martinez-Lopez
- Angiology and Vascular Surgery Department. Hospital Universitario y Politécnico La Fe, Valencia
| | - E Plana-Andani
- Angiology and Vascular Surgery Department. Hospital Universitario y Politécnico La Fe, Valencia; Research Group on hemostasis, Thrombosis, Arteriosclerosis and Vascular Biology. Instituto de Investigación Sanitara-Hospital La Fe, Valencia
| | - P Medina
- Research Group on hemostasis, Thrombosis, Arteriosclerosis and Vascular Biology. Instituto de Investigación Sanitara-Hospital La Fe, Valencia
| | - A Hernandiz-Martinez
- Research Group on Regeneration and Heart Transplantation. Instituto de Investigación Sanitara-Hospital La Fe, Valencia
| | - M Miralles-Hernández
- Angiology and Vascular Surgery Department. Hospital Universitario y Politécnico La Fe, Valencia; Research Group on hemostasis, Thrombosis, Arteriosclerosis and Vascular Biology. Instituto de Investigación Sanitara-Hospital La Fe, Valencia.
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Alloush TK, Alloush AT, Marzouk F, Abdulghani KO, Shokri HM. Post-COVID isolated subclavian artery dissection with multiple cerebral infarctions. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022; 58:114. [PMID: 36212672 PMCID: PMC9526528 DOI: 10.1186/s41983-022-00549-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/09/2022] [Indexed: 11/06/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) is a pandemic disease which predominantly affects the respiratory system with high critical care mortality and morbidity, yet it also causes multiple organs dysfunction in affected patients. There is a strong evidence that it increases the susceptibility of cerebrovascular strokes in such patients. Besides this prothrombotic complication, arterial dissection can be one of its mechanisms increasing the risks of stroke. Case presentation Herein, we report a case of spontaneous isolated subclavian artery dissection in a COVID-19 patient. Sixty-one-year-old female presented with spontaneous isolated subclavian artery dissection without any traumatic events nor history of connective tissue disorders. She had left upper limb ischemia followed by cerebellar, thalamic and occipital infarctions. Whether this patient’s subclavian artery dissection was triggered by exaggerated inflammatory response or arteriopathy secondary to COVID-19 remains speculative. Conclusions Nonetheless, arterial dissection can be one of its complications, it is essential for treating physicians to be attentive for the diversity of COVID-19 clinical manifestations.
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Affiliation(s)
- Taha K. Alloush
- grid.7269.a0000 0004 0621 1570Department of Neurology and Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Adel T. Alloush
- grid.7269.a0000 0004 0621 1570Department of Geriatrics and Gerontology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Fayez Marzouk
- Departement of Vascular Surgery, The Good Shepherd, Italian and alHaya Hospitals, Cairo, Egypt
| | - Khaled O. Abdulghani
- grid.412093.d0000 0000 9853 2750Department of Neurology and Psychiatry, Helwan University School of Medicine, Cairo, Egypt
| | - Hossam M. Shokri
- grid.7269.a0000 0004 0621 1570Department of Neurology and Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Hale BW, Lu JC, Romano JC, Lowery R, Yu S, Norris MD. Kommerell diverticulum: distinctions between arch side, and evaluation of morphology, size, and risk. Ann Thorac Surg 2021; 114:848-856. [PMID: 34283954 DOI: 10.1016/j.athoracsur.2021.06.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 05/05/2021] [Accepted: 06/01/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Kommerell diverticulum (KD) is a dilated proximal aberrant subclavian artery associated with either right or left aortic arches (RAA-ARSA or LAA-ALSA). Although case series suggest KD may be a liability for vascular complications, the risk, pattern of dilation throughout the lifespan, and differences between arch sides, are not known. METHODS A single-center retrospective review of patients of all ages with KD on cross-sectional imaging. Maximal short axis diameter of KD (KDmax), absolute and indexed to descending aortic (DAo) diameter, was correlated with age. Comparisons were made between arch sides. Patients with vascular complications are described. RESULTS One hundred and four patients with KD were included [68 (65%) RAA-ALSA, 36 (35%) LAA-ARSA; 43 (41%) asymptomatic]. Although KDmax was correlated with age (RAA-ALSA r=0.84 [p<.0001]; LAA-ARSA r=0.51 [p=0.001]), KDmax/DAo was not (RAA-ALSA r=0.14 [p=0.27]; LAA-ARSA r=-0.22 [p=0.21]). RAA-ALSA had larger KDmax/DAo (1.02±0.20 vs 0.89±0.18 mm/mm, p=0.002), more symptoms (75% vs 28%, p <.0001), and younger age (median 9.5 vs 61.7 years, p<.0001). Six patients had vascular complications, age 58-80 years, all with LAA-ARSA and risk factors for acquired aneurysms. CONCLUSIONS In older patients, KDmax/DAo was not larger, arguing against isolated KD dilation with age. Diverticula from RAA-ALSA and LAA-ARSA demonstrate different phenotypes, suggesting different disease processes and likely different risk. The incidence of vascular complication was lower than previous reports, and occurred exclusively in patients with LAA-ARSA and aneurysm risk factors. This suggests conservative management of asymptomatic KD is often reasonable, especially with RAA-ALSA.
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Affiliation(s)
- Benjamin W Hale
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan; University of Michigan Adult Congenital Heart Disease Program, Ann Arbor, Michigan.
| | - Jimmy C Lu
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Jennifer C Romano
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Ray Lowery
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Sunkyung Yu
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Mark D Norris
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan; University of Michigan Adult Congenital Heart Disease Program, Ann Arbor, Michigan
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Saran N, Pochettino A. Management of Coarctation and Aortic Arch Anomalies in the Adult. Semin Thorac Cardiovasc Surg 2021; 33:1061-1068. [PMID: 34091017 DOI: 10.1053/j.semtcvs.2021.04.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/08/2021] [Accepted: 04/28/2021] [Indexed: 11/11/2022]
Abstract
Congenital Aortic arch malformations are rare in adults. Often they present with hypertension or tracheoesophageal compression. The involved anatomy is dependent on the sidedness of the aortic arch and the variable development of the primitive pharyngeal arches. Sternotomy and thoracotomy are usually required for surgical repair, while need for circulatory arrest is not uncommon. With caution and adequate planning, surgery can be carried out with satisfactory results.
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Affiliation(s)
- Nishant Saran
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester
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Gray SE, Scali ST, Feezor RJ, Beaver TM, Back MR, Upchurch GR, Huber TS, Fatima J. Safety and efficacy of a hybrid approach for repair of complicated aberrant subclavian arteries. J Vasc Surg 2020; 72:1873-1882. [PMID: 32665182 DOI: 10.1016/j.jvs.2020.01.075] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 01/22/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Aberrant subclavian artery (ASA), a well-described aortic arch anomaly, is frequently associated with dysphagia and development of Kommerell diverticulum (KD) with aneurysmal degeneration. Historically, open repair has been performed, which can be associated with significant morbidity. More recently, hybrid approaches using different arch vessel revascularization techniques in combination with thoracic endovascular aortic repair (hybrid TEVAR) have been described, but there is a paucity of literature describing outcomes. The objective of this analysis was to describe our experience with management of complicated ASAs using hybrid TEVAR, further adding to the literature describing approaches to and outcomes of hybrid ASA repair. METHODS A retrospective, single-institution review was performed of all patients treated for ASA complications using hybrid TEVAR (2002-2018). The primary end point was technical success, defined as absence of type I or type III endoleak intraoperatively and within 30 days postoperatively. Secondary end points included complications, reintervention, and survival. Centerline measurement of KD diameters (maximum diameter = opposing aortic outer wall to diverticulum apex) was employed. Kaplan-Meier methodology was used to estimate secondary end points. RESULTS Eighteen patients (1.4% of 1240 total TEVAR procedures; male, 67%; age, 59 ± 13 years) were identified (left-sided arch and right ASA, 94% [n = 17]; right-sided arch and left ASA, n = 1 [6%]; retroesophageal location and associated KD, 100%); median preoperative KD diameter was 60 mm (interquartile range [IQR], 37-108 mm). Operative indications included diverticulum diameter (61%), dysphagia (17%), rupture (11%), rapid expansion (6%), and endoleak after TEVAR (6%). All procedures used some combination of supraclavicular revascularization and TEVAR (staged, 50% [n = 9]), whereas partial open arch reconstruction was used in 17% (n = 3). There were no perioperative deaths or spinal cord ischemic events. Major complications occurred in 22% (n = 4): nondisabling stroke, one; arm ischemia, one; upper extremity neuropathy, one; and iatrogenic descending thoracic aortic dissection, one. Technical success was 83%, but 44% (n = 8) had an endoleak (type I, n = 3; type II, n = 5 [intercostal, n = 2; aneurysmal subclavian artery origin, n = 3]) during follow-up (median, 4 months; IQR, 1-15 months). Two endoleaks resolved spontaneously, three were treated, and three were observed (1-year freedom from reintervention, 75% ± 10%). Median KD diameter decreased by 7 mm (IQR, 1-12 mm), and 78% (n = 14) experienced diameter reduction or stability in follow-up. The 1- and 3-year survival was 93% ± 6% and 84% ± 10%, respectively. CONCLUSIONS Hybrid open brachiocephalic artery revascularization with TEVAR appears to be safe and reasonably effective in management of ASA complications as evidenced by a low perioperative complication risk and reasonable positive aortic remodeling. However, endoleak rates raise significant concerns about durability. Therefore, if this technique is employed, the mandatory need for surveillance and high rate of reintervention should be emphasized preoperatively. This analysis represents a relatively large series of a hybrid TEVAR technique to treat ASA complications, but greater patient numbers and longer follow-up are needed to further establish the role of this procedure.
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Affiliation(s)
- Sarah E Gray
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Salvatore T Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Robert J Feezor
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Thomas M Beaver
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Fla
| | - Martin R Back
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Gilbert R Upchurch
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Thomas S Huber
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Javairiah Fatima
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla.
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Saran N, Dearani J, Said S, Fatima B, Schaff H, Bower T, Pochettino A. Vascular Rings in Adults: Outcome of Surgical Management. Ann Thorac Surg 2019; 108:1217-1227. [DOI: 10.1016/j.athoracsur.2019.04.097] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 04/10/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022]
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Right Aortic Arch, Kommerell Diverticulum, and Symptomatic Retro-Esophageal Vascular Ring in an Adult (Case Presentation and Review). Int Surg 2019. [DOI: 10.9738/intsurg-d-14-00152.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 24 year-old Hispanic man presented with progressive retrosternal chest pain, shortness of breath, and dysphagia. Chest X-ray, computed tomography angiography, and magnetic resonance (MRA) studies were compatible with a right aortic arch and a 3.5-cm descending right aortic Kommerell diverticulum. Barium esophagogram and esophagoscopy demonstrated a constricting band crossing the esophagus at the level of the diverticulum. After discussion with other cardiothoracic surgeons, with a combined 300 years of experience, they reported only 1 other possible such case. Kommerell's diverticula are usually repaired in children and rarely are seen in the adult. Kommerell diverticular treatment options include endovascular stenting, cardiopulmonary bypass with resection and grafting, right thoracotomy, and a cervical approach. Because of the patient's findings of a right arch, a Kommerell diverticulum, and a constricting band causing esophageal compression and respiratory distress, it was felt stenting alone would not relieve his symptoms. Therefore, we used a left third posterior intercostal thoracotomy approach to resect the constricting esophageal band connecting the Kommerell diverticulum to the left subclavian artery and to perform the Kommerell diverticulectomy. Releasing the esophageal and tracheal compressing band and resection of the diverticulum provided complete symptom relief with elimination of the dysphagia, dyspnea, wheezing, and chest pain, using a single surgical procedure.
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Jeon K, Cho HJ. Spontaneous Subclavian Artery Dissection Presenting as Posterior Circulation Infarction. JOURNAL OF NEUROCRITICAL CARE 2017. [DOI: 10.18700/jnc.170013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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10
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Qing KX, Yang B, Cai HB, Jin H. Successful Endovascular Repair in a Patient with Isolated Proximal Subclavian Artery Dissecting Aneurysm: Case Report and Literature Review. Ann Vasc Surg 2016; 35:206.e5-8. [DOI: 10.1016/j.avsg.2016.01.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 01/07/2016] [Accepted: 01/18/2016] [Indexed: 11/15/2022]
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Kochupura PV, Greelish JP. Staged Hybrid Repair of an Intrathoracic Subclavian Artery Aneurysm Associated with a Long Segment Dissection. Ann Vasc Surg 2015; 30:306.e1-3. [PMID: 26362621 DOI: 10.1016/j.avsg.2015.05.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 05/06/2015] [Accepted: 05/19/2015] [Indexed: 11/28/2022]
Abstract
Intrathoracic subclavian artery aneurysms (ISAAs) are infrequently seen in clinical practice. We report the repair of a left ISAA associated with a long segment dissection from the ostia extending to the axillary artery. A hybrid approach was used. Carotid-to-axillary bypass using a reversed greater saphenous vein was first performed, followed by coverage of the origin of the subclavian artery using a thoracic stent graft. Finally, percutaneous access of the radial artery with coil embolization was performed to successfully thrombose the ISAA.
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Affiliation(s)
- Paul V Kochupura
- Department of Vascular Surgery, CaroMont Regional Medical Center, Gastonia, NC.
| | - James P Greelish
- Department of Vascular Surgery, CaroMont Regional Medical Center, Gastonia, NC
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Tanaka A, Milner R, Ota T. Kommerell's diverticulum in the current era: a comprehensive review. Gen Thorac Cardiovasc Surg 2015; 63:245-59. [PMID: 25636900 DOI: 10.1007/s11748-015-0521-3] [Citation(s) in RCA: 124] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Indexed: 11/30/2022]
Abstract
Kommerell's diverticulum is a developmental error with a remnant of fourth dorsal aortic arch, named after Dr. Kommerell, a radiologist, who made the first diagnosis in a living individual. The diverticulum can occur in both the left and right aortic arch, from which an aberrant subclavian artery rises to the contralateral side. Pediatric patients often present with airway symptoms whereas dysphagia and chest discomfort are more common in the adult patients. Computed tomography or magnetic resonance imaging can provide details of the diverticulum, associated arch anomalies, and its relationship with surrounding organs. Recent histological studies indicated the presence of cystic medial necrosis in the diverticulum wall, which would explain the reported high rates of aortic dissection and rupture associated with the diverticulum. Accumulated knowledge on this entity and the recent advancement of imaging techniques, surgical/endovascular strategies, and perioperative management, have led to more aggressive intervention to the diverticulum in the early phase. While still under debate it is generally accepted to consider surgical intervention when the diameter of the diverticulum orifice exceeds over 30 mm, and/or the diameter of the descending aorta adjacent to the diverticulum exceeds over 50 mm. Treatment options include open surgical repair, hybrid endovascular repair, and total endovascular repair. The selection of treatment strategy for Kommerell's diverticulum should be based on the anatomy, comorbidities of the patient, and surgical expertise available. The summaries of open and endovascular repairs of over 210 cases from literature search from 2004 to 2014 are also provided in this review.
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Affiliation(s)
- Akiko Tanaka
- Department of Surgery, Section of Cardiac and Thoracic Surgery, University of Chicago, 5841 Maryland Avenue, Suite E-500/MC5040, Chicago, IL, 60637, USA
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Catanese V, Alberto Pegorer M, Bissacco D, Di Gregorio S, Dallatana R, Settembrini P. Conservative management in a young woman affected by isolated left subclavian artery dissection. Ann Vasc Dis 2014; 7:347-9. [PMID: 25298844 PMCID: PMC4180704 DOI: 10.3400/avd.cr.14-00060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 07/22/2014] [Indexed: 11/13/2022] Open
Abstract
Subclavian Artery Dissection (SAD) is a rare condition, generally due to arterial catheterization, blunt trauma or connective tissue disease. Spontaneous or minimally traumatic cases have also been reported. Clinical manifestations are usually chest and/or back pain, pulse loss and paresthesia, whereas nausea, dizziness and vomiting are present in case of involvement of the vertebral artery. We report an unusual case of a young woman presenting isolated left SAD after traffic accident, minimally symptomatic, and treated with medical therapy alone. A conservative management and a closed follow-up appear to be a safe approach in patients affected by uncomplicated SAD without other comorbidities.
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Affiliation(s)
- Vincenzo Catanese
- Division of Vascular Surgery, San Carlo Borromeo Hospital, Milan, Italy
| | | | - Daniele Bissacco
- Division of Vascular Surgery, San Carlo Borromeo Hospital, Milan, Italy
| | - Sara Di Gregorio
- Division of Vascular Surgery, San Carlo Borromeo Hospital, Milan, Italy
| | | | - Piergiorgio Settembrini
- Division of Vascular Surgery, San Carlo Borromeo Hospital, Milan, Italy ; Chair of Vascular Surgery, University of Milan, Milan, Italy
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Samura M, Zempo N, Ikeda Y, Kaneda Y, Suzuki K, Tsuboi H, Hamano K. Chimney Technique for Aortic Dissection Involving an Aberrant Right Subclavian Artery. Ann Thorac Surg 2014; 97:315-7. [DOI: 10.1016/j.athoracsur.2013.05.094] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 03/07/2013] [Accepted: 05/02/2013] [Indexed: 01/20/2023]
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Bhandary SP, Papadimos TJ, Svensson LG, Sale S. Anesthetic management of the resection of a Kommerell's diverticulum. J Cardiothorac Vasc Anesth 2013; 29:142-5. [PMID: 24332920 DOI: 10.1053/j.jvca.2013.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Sujatha P Bhandary
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH.
| | - Thomas J Papadimos
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH
| | - Shiva Sale
- Department of Anesthesiology, Cleveland Clinic, Cleveland, OH
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Andersen ND, Barfield ME, Hanna JM, Shah AA, Shortell CK, McCann RL, Hughes GC. Intrathoracic subclavian artery aneurysm repair in the thoracic endovascular aortic repair era. J Vasc Surg 2013; 57:915-25. [DOI: 10.1016/j.jvs.2012.09.074] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 09/26/2012] [Accepted: 09/27/2012] [Indexed: 10/27/2022]
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Yu PJ, Balsam LB, Mussa FF, DeAnda A. Aberrant left subclavian artery associated with a Kommerell's diverticulum and a left-sided aortic arch. J Card Surg 2012; 27:607-8. [PMID: 22978838 DOI: 10.1111/j.1540-8191.2012.01520.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Kommerell's diverticulum is most commonly associated with either an aberrant left subclavian artery from a right-sided aortic arch or an aberrant right subclavian artery from a left-sided aortic arch. We describe an exceedingly rare case of an aberrant left subclavian artery arising from a Kommerell's diverticulum in a patient with a left-sided aortic arch, the "nonaberrant aberrant left subclavian artery."
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Affiliation(s)
- Pey-Jen Yu
- Department of Cardiothoracic Surgery, New York University School of Medicine, New York, NY 10016, USA
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