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Rodríguez-Pérez Á, Tello-Diaz C, Vergara-Budding AC, Fernández-Vinzenzi C, Hakim Moustafa A, Acebes Pinilla C, Ginel-Iglesias A, Barros-Membrilla AJ, Dilme-Muñoz JF. Case Report: Kommerell's diverticulum and left aberrant subclavian artery stenosis hybrid treatment with branched aortic stent-graft. Front Cardiovasc Med 2023; 10:1309839. [PMID: 38155991 PMCID: PMC10754508 DOI: 10.3389/fcvm.2023.1309839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 11/21/2023] [Indexed: 12/30/2023] Open
Abstract
Kommerell's diverticulum in association with left or right aberrant subclavian arteries is a rare finding and is challenging to treat. Contemporary surgical and endovascular techniques provide a broad arsenal of possible treatments. Imaging techniques and modeling technology allow a more personalized strategy for each patient. In this case, we present a symptomatic patient with a Kommerell's diverticulum and a left aberrant subclavian artery complicated by proximal stenosis and poststenotic aneurysm. A hybrid technique using a single-branched thoracic stent-graft (Castor, MicroPort Medical, Shanghai, China) in combination with a surgical left subclavian-carotid bypass and endovascular occlusion of the poststenotic aneurysm using a vascular plug device (Amplatzer Vascular Plug, Abbott, Chicago, United States) was performed. This approach was planned and facilitated by the use of a 3D model. Alternative treatment options and the strengths of this approach are briefly reviewed and discussed.
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Affiliation(s)
- Álvaro Rodríguez-Pérez
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, UAB, IIB Sant Pau, CIBERCV ISCIII, Barcelona, Spain
| | - Cristina Tello-Diaz
- Department of Vascular and Endovascular Surgery, Hospital de la Santa Creu I Sant Pau, Institute of Biomedical Research (II-B Sant Pau), CIBER CV, UAB, Barcelona, Spain
| | - A. Carolina Vergara-Budding
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, UAB, IIB Sant Pau, CIBERCV ISCIII, Barcelona, Spain
| | | | - Abdel Hakim Moustafa
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, UAB, IIB Sant Pau, CIBERCV ISCIII, Barcelona, Spain
- Dimension Lab, Hospital de la Santa Creu I Sant Pau, UAB, Barcelona, Spain
| | | | | | - Antonio J. Barros-Membrilla
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, UAB, IIB Sant Pau, CIBERCV ISCIII, Barcelona, Spain
| | - Jaime Felix Dilme-Muñoz
- Department of Vascular and Endovascular Surgery, Hospital de la Santa Creu I Sant Pau, Institute of Biomedical Research (II-B Sant Pau), CIBER CV, UAB, Barcelona, Spain
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2
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Flinn AN, Meitz D, Hart TG, Causey MW. Thoracic branch endoprosthesis repair of grade 3 blunt aortic injury in the setting of an aberrant retroesophageal right subclavian artery. J Vasc Surg 2023; 78:1074-1075. [PMID: 37739740 DOI: 10.1016/j.jvs.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Ashley N Flinn
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, TX.
| | - Daltrey Meitz
- Department of Radiology, Brooke Army Medical Center, Fort Sam Houston, TX
| | - Theodore G Hart
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, TX
| | - Marlin W Causey
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, TX
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3
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Chourda E, Putotto C, Versacci P, Saltarocchi S, D'Abramo M, Tshomba Y, Tinelli G, Miraldi F. Hybrid Single-Stage Repair of Kommerell's Diverticulum in a Right Aortic Arch in a Patient With 22q11.2 Deletion Syndrome. Vasc Endovascular Surg 2022; 56:595-601. [PMID: 35442127 DOI: 10.1177/15385744221090911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hybrid single-stage repair of Kommerell's diverticulum in a right aortic arch.Aortic arch anomalies, isolated or associated with congenital heart defects, are cardiovascular manifestations frequently associated with 22q11.2 deletion syndrome. Kommerell's diverticulum in the context of a right aortic arch is an exceedingly rare congenital anomaly, consisting in aneurysmal degeneration of the origin of an aberrant left subclavian artery. Open surgical repair has been the treatment paradigm, but in recent years, hybrid and endovascular procedures have also been proposed. In this report we present the case of a patient affected by 22q11.2 deletion syndrome successfully treated for Kommerell's diverticulum associated with a right-sided aortic arch through a single-stage hybrid procedure, consisting of bilateral carotid-subclavian bypass, exclusion of the diverticulum by an endovascular thoracic stent graft, and aberrant left subclavian artery plug occlusion. This type of hybrid technique can be an excellent alternative to extensive open surgical repairs or when total endovascular repair is deemed unachievable, also in the context of a complex genetic syndrome.
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Affiliation(s)
- Emmanouela Chourda
- Department of Clinical, Internal Medicine, Anaesthesiology and Cardiovascular Sciences, 9311Sapienza University of Rome, Rome, Italy
| | - Carolina Putotto
- Department of Pediatrics, Obstetrics and Gynecology, 9311Sapienza University of Rome, Rome, Italy
| | - Paolo Versacci
- Department of Pediatrics, Obstetrics and Gynecology, 9311Sapienza University of Rome, Rome, Italy
| | - Sara Saltarocchi
- Department of Clinical, Internal Medicine, Anaesthesiology and Cardiovascular Sciences, 9311Sapienza University of Rome, Rome, Italy
| | - Mizar D'Abramo
- Department of Clinical, Internal Medicine, Anaesthesiology and Cardiovascular Sciences, 9311Sapienza University of Rome, Rome, Italy
| | - Yamume Tshomba
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 96983Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Tinelli
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 96983Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabio Miraldi
- Department of Clinical, Internal Medicine, Anaesthesiology and Cardiovascular Sciences, 9311Sapienza University of Rome, Rome, Italy
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Zavatta M, Squizzato F, Dall'Antonia A, Piazza M, Antonello M. The Chimney/Periscope Technique as Total Endovascular Treatment of Kommerell's Diverticulum. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2021; 9:158-160. [PMID: 34715698 PMCID: PMC8642075 DOI: 10.1055/s-0041-1729850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We report a case of Kommerell's diverticulum (KD) treated with a total endovascular approach, maintaining supra-aortic trunk (SAT) patency. A 75 year-old female with aneurysmal KD was deemed unsuitable for open surgery. Landing zone 2 was unfeasible; therefore, we planned an endovascular approach with landing in zone 1, chimney to left subclavian artery and periscope to right subclavian artery. Postoperatively she was free from complications, with complete exclusion of KD and SAT patency at 3-year follow-up.
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Affiliation(s)
- Marco Zavatta
- Department of Cardiac, Thoracic and Vascular Sciences, Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Padova, Italy
| | - Francesco Squizzato
- Department of Cardiac, Thoracic and Vascular Sciences, Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Padova, Italy
| | - Alberto Dall'Antonia
- Department of Cardiac, Thoracic and Vascular Sciences, Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Padova, Italy
| | - Michele Piazza
- Department of Cardiac, Thoracic and Vascular Sciences, Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Padova, Italy
| | - Michele Antonello
- Department of Cardiac, Thoracic and Vascular Sciences, Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Padova, Italy
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5
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Fan W, Tan J, Shi W, Rong J, Yu B. A Systematic Review of Total Thoracic Endovascular Aortic Repair in Treatment of Kommerell Diverticulum Combined with Right-Sided Aortic Arch. Med Sci Monit 2021; 27:e930031. [PMID: 33755659 PMCID: PMC7999715 DOI: 10.12659/msm.930031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Kommerell diverticulum (KD) combined with right-sided aortic arch (RAA) and aberrant left subclavian artery (ALSA) are rare and limited to a few case reports and small series. Thoracic endovascular aortic repair (TEVAR), which is mini-invasive, is widely utilized in complicated aortic disease. We performed a systematic review of the literature to identify all patients who underwent endovascular repair for KD in terms of technical feasibility and procedural outcomes. Published and accepted studies only in English as well as article reference lists were searched and extracted to assess case series reporting solely TEVAR in KD patients. There were 28 patients with KD/RAA identified from 19 studies. All of them underwent endovascular technique for KD exclusion and the median age was 69 years (range 39-83 years). Hypertension (n=17) was the most common comorbidity in this cohort, followed by diabetes mellitus (n=3), hyperlipidemia (n=3), and smoking (n=3). The presenting symptoms were dysphagia (n=8, 29%), intermittent back pain (n=4, 14%), and acute aortic dissection (n=6, 21%), while asymptomatic was found in 9 patients (n=9, 32%). A technical success rate of 100% was reported associated with various managements of ALSA, proximal embolization (n=19, 68%), in-situ revascularization (n=3, 11%), and left carotid-subclavian bypass (n=3, 11%). All patients survived without severe complications and were discharged home within less than 14 days. The mean follow-up time was 9.3 months, patency was found in all patients, thrombosis and distinct shrinkage of KD aneurysm as indicated by CT-scans were noted (n=20, 71%), and type II endoleak was found in only 4 patients (n=4, 14%). TEVAR appears to be safe and offers favorable results, but it still needs substantial evidence to support routine use in KD. TEVAR is an alternative to open repair in selected cases, but it needs further investigation in a large cohort.
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Affiliation(s)
- Weijian Fan
- Department of Vascular Surgery, Suzhou Traditional Chinese medicine (TCM) Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, Jiangsu, China (mainland).,Department of Vascular Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China (mainland)
| | - Jinyun Tan
- Department of Vascular Surgery, Huashan Hospital of Fudan University, Shanghai, China (mainland)
| | - Weihao Shi
- Department of Vascular Surgery, Huashan Hospital of Fudan University, Shanghai, China (mainland)
| | - Jianjie Rong
- Department of Vascular Surgery, Suzhou Traditional Chinese medicine (TCM) Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, Jiangsu, China (mainland)
| | - Bo Yu
- Department of Vascular Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China (mainland).,Department of Vascular Surgery, Huashan Hospital of Fudan University, Shanghai, China (mainland)
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7
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Chang Y, Guo HW, Yu CT, Sun XG, Chang Q, Qian XY. Surgical treatment for Kommerell's diverticulum associated with aortic dissection involving aortic arch. J Card Surg 2019; 34:1273-1278. [PMID: 31475407 DOI: 10.1111/jocs.14244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Kommerell diverticulum with aortic dissection involving aortic arch is a rare but troublesome condition. The purpose of this study is to summarize the experience and strategy of surgical treatment. METHOD From November 2015 to January 2018, seven consecutive patients underwent surgical treatment in our institution. Three patients with acute type A aortic dissection and one patient with acute type B aortic dissection received total arch replacement and frozen elephant trunk (FET) implantation through median sternotomy. Three patients with chronic type B aortic dissection underwent total aortic arch and descending aorta replacement through median sternotomy and lateral thoracotomy. RESULT There were seven male patients whose median age was 42.3 ± 11.7 (from 14 to 54) years old. There was no perioperative death in this study. One patient had postoperative critical illness polyneuropathy and required prolonged mechanical ventilation (485 hours) and recovered finally. Follow up was completed for all seven patients with a median follow-up time of 7 (3-46) months. One patient with type A dissection developed aneurysm of the descending aorta distal to the FET and received reintervention. No clinical events and abnormal computed tomography manifestations were found in the other seven patients. CONCLUSION Total arch replacement and FET through single median incision is a reliable method for Kommerell diverticulum associated with acute dissection involving arch. For Kommerell diverticulum associated with chronic type A or B aortic dissection involving aortic arch, graft replacement by double or single incision is safe and appropriate.
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Affiliation(s)
- Yi Chang
- Department of Vascular Surgery, Fuwai Hospital, Cardiovascular Institute, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hong-Wei Guo
- Department of Vascular Surgery, Fuwai Hospital, Cardiovascular Institute, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Cun-Tao Yu
- Department of Vascular Surgery, Fuwai Hospital, Cardiovascular Institute, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiao-Gang Sun
- Department of Vascular Surgery, Fuwai Hospital, Cardiovascular Institute, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Qian Chang
- Department of Vascular Surgery, Fuwai Hospital, Cardiovascular Institute, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiang-Yang Qian
- Department of Vascular Surgery, Fuwai Hospital, Cardiovascular Institute, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Kozlov BN, Panfilov DS, Saushkin VV, Nasrashvili GG, Kuznetsov MS, Shipulin VM. [Mid-term results of hybrid treatment of aortic dissection combined with Kommerell's diverticulum]. Khirurgiia (Mosk) 2017:72-76. [PMID: 29186101 DOI: 10.17116/hirurgia20171172-76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- B N Kozlov
- Tomsk National Research Medical Center of the Russian Academy of Sciences, Cardiology Research Institute, Tomsk, Russia
| | - D S Panfilov
- Tomsk National Research Medical Center of the Russian Academy of Sciences, Cardiology Research Institute, Tomsk, Russia
| | - V V Saushkin
- Tomsk National Research Medical Center of the Russian Academy of Sciences, Cardiology Research Institute, Tomsk, Russia
| | - G G Nasrashvili
- Tomsk National Research Medical Center of the Russian Academy of Sciences, Cardiology Research Institute, Tomsk, Russia
| | - M S Kuznetsov
- Tomsk National Research Medical Center of the Russian Academy of Sciences, Cardiology Research Institute, Tomsk, Russia
| | - V M Shipulin
- Tomsk National Research Medical Center of the Russian Academy of Sciences, Cardiology Research Institute, Tomsk, Russia
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9
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Lococo F, Tusini N, Brandi L, Leuzzi G, Galeone C, Paci M, Rapicetta C. Successful Conservative Treatment of a Kommerell Aneurysm Associated With Right-Sided Aortic Arch. Vasc Endovascular Surg 2016; 50:458-9. [PMID: 27334477 DOI: 10.1177/1538574416655891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Right-side aortic arch is a rare congenital aortic anomaly occurring in 0.05% to 0.1% of the general population. Approximately, half of these cases may be associated with an aberrant left subclavian artery and occasionally with aneurysmatic change at its origin known as Kommerell diverticulum or aneurysm (KA). Herein we report a challenging case of a right-side aortic arch associated with KA incidentally observed in a 73-year-old male with metastatic lung cancer. After careful multidisciplinary discussion, a conservative strategy of care was successfully adopted.
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Affiliation(s)
- Filippo Lococo
- Unit of Thoracic Surgery, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Nicola Tusini
- Unit of Vascular Surgery, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Loris Brandi
- Unit of Thoracic Surgery, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Giovanni Leuzzi
- Thoracic Surgery Unit, IRCCS Istituto Nazionale dei Tumori Foundation, Milan, Italy
| | - Carla Galeone
- Unit of Thoracic Surgery, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Massimiliano Paci
- Unit of Thoracic Surgery, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Cristian Rapicetta
- Unit of Thoracic Surgery, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
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10
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Hajibandeh S, Hajibandeh S, Antoniou SA, Torella F, Antoniou GA. Revascularisation of the left subclavian artery for thoracic endovascular aortic repair. Cochrane Database Syst Rev 2016; 4:CD011738. [PMID: 27119426 PMCID: PMC8266261 DOI: 10.1002/14651858.cd011738.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Controversy exists as to whether revascularisation of the left subclavian artery (LSA) confers improved outcomes in patients undergoing thoracic endovascular aortic repair (TEVAR). Even though preemptive revascularisation of the LSA has theoretical advantages, including a reduced risk of ischaemic damage to vital organs, such as the brain and the spinal cord, it is not without risks. Current practice guidelines recommend routine revascularisation of the LSA in patients undergoing elective TEVAR where achievement of a proximal seal necessitates coverage of the LSA, and in patients who have an anatomy that compromises perfusion to critical organs. However, this recommendation was based on very low-quality evidence. OBJECTIVES To assess the comparative efficacy of routine LSA revascularisation versus either selective or no revascularisation in patients with descending thoracic aortic disease undergoing TEVAR with coverage of the LSA origin. SEARCH METHODS The Cochrane Vascular Trials Search Co-ordinator (TSC) searched the Specialised Register (June 2015). In addition, the TSC searched the Cochrane Register of Studies (CENTRAL (2015, Issue 5)).Trials databases were also searched (June 2015). SELECTION CRITERIA We had planned to consider all randomised controlled trials (RCTs) that compared routine revascularisation of the LSA with selective or no revascularisation, in patients undergoing TEVAR. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the title and abstract of articles identified through literature searches. An independent third review author was consulted in the event of disagreement. We had planned for two review authors to independently extract data and assess the risk of bias of identified trials using the criteria recommended in the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS We did not identify any RCTs relevant to our review topic. Therefore, no quantitative analysis was conducted. AUTHORS' CONCLUSIONS High quality RCT evidence for or against routine or selective revascularisation of the LSA in TEVAR is not currently available. It is not possible to draw conclusions with regard to the optimal management of LSA coverage in TEVAR, and whether routine revascularisation, which was defined as the intervention of interest in our review, confers beneficial effects, as indicated by reduced mortality, cerebrovascular events, and spinal cord ischaemia. This review highlights the need for continued research to provide RCT evidence and define the role of LSA revascularisation in the context of TEVAR with coverage of the LSA.
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Affiliation(s)
- Shahin Hajibandeh
- Royal Liverpool University HospitalLiverpool Vascular and Endovascular ServicePrescot StreetLiverpoolUKL78XP
| | - Shahab Hajibandeh
- Royal Liverpool University HospitalLiverpool Vascular and Endovascular ServicePrescot StreetLiverpoolUKL78XP
| | - Stavros A Antoniou
- University Hospital of Heraklion, University of CreteDepartment of SurgerySouniou 11HeraklionGreece19001
| | - Francesco Torella
- Royal Liverpool University HospitalLiverpool Vascular and Endovascular ServicePrescot StreetLiverpoolUKL78XP
| | - George A Antoniou
- The Royal Oldham Hospital, Pennine Acute Hospitals NHS TrustDepartment of Vascular and Endovascular SurgeryManchesterUK
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11
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Barr JG, Sepehripour AH, Jarral OA, Tsipas P, Kokotsakis J, Kourliouros A, Athanasiou T. A review of the surgical management of right-sided aortic arch aneurysms. Interact Cardiovasc Thorac Surg 2016; 23:156-62. [PMID: 27001673 DOI: 10.1093/icvts/ivw058] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 12/19/2015] [Indexed: 11/15/2022] Open
Abstract
Aneurysms and dissections of the right-sided aortic arch are rare and published data are limited to a few case reports and small series. The optimal treatment strategy of this entity and the challenges associated with their management are not yet fully investigated and conclusive. We performed a systematic review of the literature to identify all patients who underwent surgical or endovascular intervention for right aortic arch aneurysms or dissections. The search was limited to the articles published only in English. We focused on presentation and critically assessed different management strategies and outcomes. We identified 74 studies that reported 99 patients undergoing surgical or endovascular intervention for a right aortic arch aneurysm or dissection. The median age was 61 years. The commonest presenting symptoms were chest or back pain and dysphagia. Eighty-eight patients had an aberrant left subclavian artery with only 11 patients having the mirror image variant of a right aortic arch. The commonest pathology was aneurysm arising from a Kommerell's diverticulum occurring in over 50% of the patients. Twenty-eight patients had dissections, 19 of these were Type B and 9 were Type A. Eighty-one patients had elective operations while 18 had emergency procedures. Sixty-seven patients underwent surgical treatment, 20 patients had hybrid surgical and endovascular procedures and 12 had totally endovascular procedure. There were 5 deaths, 4 of which were in patients undergoing emergency surgery and none in the endovascular repair group. Aneurysms and dissections of a right-sided aortic arch are rare. Advances in endovascular treatment and hybrid surgical and endovascular management are making this rare pathology amenable to these approaches and may confer improved outcomes compared with conventional extensive repair techniques.
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Affiliation(s)
- James G Barr
- Department of Cardiac Surgery, Royal Brompton and Harefield NHS Trust, Harefield Hospital, London, UK
| | - Amir H Sepehripour
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Omar A Jarral
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Pantelis Tsipas
- Department of Cardiothoracic Surgery, Evangelismos Hospital, Athina, Greece
| | - John Kokotsakis
- Department of Cardiothoracic Surgery, Evangelismos Hospital, Athina, Greece
| | - Antonios Kourliouros
- Department of Cardiac Surgery, Royal Brompton and Harefield NHS Trust, Harefield Hospital, London, UK
| | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
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12
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Kozlov BN, Panfilov DS, Saushkin VV, Shipulin VM. Hybrid treatment of aortic dissection associated with Kommerell's diverticulum. Interact Cardiovasc Thorac Surg 2016; 22:854-5. [PMID: 26921885 DOI: 10.1093/icvts/ivw031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 01/11/2016] [Indexed: 11/12/2022] Open
Abstract
This clinical case demonstrates a successful simultaneous approach for Type B aortic dissection in association with Kommerell's diverticulum using an E-vita OPEN PLUS Hybrid prosthesis. Computed tomography in the early postoperative period and after a 6-month follow-up showed favourable surgical outcomes.
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Affiliation(s)
- Boris N Kozlov
- Federal State Budgetary Scientific Institution, Research Institute for Cardiology, Tomsk, Russia
| | - Dmitry S Panfilov
- Federal State Budgetary Scientific Institution, Research Institute for Cardiology, Tomsk, Russia
| | - Victor V Saushkin
- Federal State Budgetary Scientific Institution, Research Institute for Cardiology, Tomsk, Russia
| | - Vladimir M Shipulin
- Federal State Budgetary Scientific Institution, Research Institute for Cardiology, Tomsk, Russia
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13
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Gao P, Wang M, Dong D, Kong X, Jin X, Zhang S. Endovascular repair of a Kommerell diverticulum anomaly. Ann Thorac Surg 2015; 99:1801-3. [PMID: 25952212 DOI: 10.1016/j.athoracsur.2014.06.094] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 05/22/2014] [Accepted: 06/09/2014] [Indexed: 11/15/2022]
Abstract
A Kommerell diverticulum (KD) may predispose toward aortic aneurysm, dissection, or rupture, although they are primarily asymptomatic. We report a case of an aberrant left subclavian artery arising from a KD in a right-side aortic arch. The lesions were successfully treated by an endovascular approach involving Amplatzer vascular plug embolization of the aberrant left subclavian artery and endovascular repair of the KD.
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Affiliation(s)
- Peixian Gao
- Department of Vascular Surgery, Provincial Hospital affiliated with Shandong University, Ji'nan, People's Republic of China
| | - Mo Wang
- Department of Vascular Surgery, Provincial Hospital affiliated with Shandong University, Ji'nan, People's Republic of China
| | - Dianning Dong
- Department of Vascular Surgery, Provincial Hospital affiliated with Shandong University, Ji'nan, People's Republic of China
| | - Xiangqian Kong
- Department of Vascular Surgery, Provincial Hospital affiliated with Shandong University, Ji'nan, People's Republic of China
| | - Xing Jin
- Department of Vascular Surgery, Provincial Hospital affiliated with Shandong University, Ji'nan, People's Republic of China
| | - Shiyi Zhang
- Department of Vascular Surgery, Provincial Hospital affiliated with Shandong University, Ji'nan, People's Republic of China.
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15
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Thoracic Endovascular Aortic Repair for Blunt Thoracic Aortic Injuries in Complex Aortic Arch Vessels Anatomies. Ann Vasc Surg 2015; 29:1320.e11-5. [DOI: 10.1016/j.avsg.2015.03.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/10/2015] [Indexed: 11/22/2022]
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16
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Antoniou GA, Antoniou SA, Torella F. Left subclavian artery coverage for thoracic endovascular aortic repair. Cochrane Database Syst Rev 2015. [DOI: 10.1002/14651858.cd011738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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17
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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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Monaco M, Lillo S, La Marca Giordano A, Contaldo A, Schiavone V. Endovascular repair of a right-sided thoracic aortic aneurysm with Kommerell diverticulum and aberrant left subclavian artery. Ann Vasc Surg 2014; 28:1323.e1-5. [PMID: 24534686 DOI: 10.1016/j.avsg.2014.01.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 01/06/2014] [Accepted: 01/12/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND A case of successful total endovascular repair of a right-sided descending thoracic aorta aneurysm (r-DTAA) with Kommerell diverticulum and aberrant left subclavian artery (ALSA) was reported. Few cases of this very rare pathology were reported, mostly describing a hybrid treatment, with only 2 cases of total endovascular repair performed to date. METHODS AND RESULTS Our strategy consisted of endovascular ALSA occlusion, without preventive revascularization, and r-DTAA exclusion by 2 endoprosthesis implanted in a telescopic fashion, first the distal one, to achieve a relative straightening of the arch and support the proximal endoprosthesis, and then the proximal one, close to the right subclavian origin. Completion angiography and 12-month computed tomography scan showed successful exclusion, patency of epiaortic vessels, and absence of endoleak. CONCLUSION Endovascular repair can be a safe and effective treatment for aortic disease with challenging anatomy, avoiding the need for a complex open surgery procedure.
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Affiliation(s)
- Mario Monaco
- Department of Vascular Surgery, Pineta Grande Hospital, Castelvolturno (CE), Italy.
| | - Stefano Lillo
- Department of Vascular Surgery, Pineta Grande Hospital, Castelvolturno (CE), Italy
| | | | - Antonio Contaldo
- Department of Vascular Surgery, Pineta Grande Hospital, Castelvolturno (CE), Italy
| | - Vincenzo Schiavone
- Department of Anesthesiology, Pineta Grande Hospital, Castelvolturno (CE), Italy
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