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Stiru O, Robu M, Platon P, Bubenek-Turconi SI, Iliescu VA, Parasca C. Hybrid Management of Dysphagia Lusoria with Tevar Implantation and Bilateral Subclavian Arteries Debranching: A Review of the Literature and a Case Report. J Pers Med 2024; 14:547. [PMID: 38929768 PMCID: PMC11204707 DOI: 10.3390/jpm14060547] [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: 04/23/2024] [Revised: 05/17/2024] [Accepted: 05/19/2024] [Indexed: 06/28/2024] Open
Abstract
Aberrant right subclavian artery (ARSA) causing dysphagia, the so-called "dysphagia lusoria", is a frequent embryologic anomaly of the aortic arch. In symptomatic patients, studies report several management options including surgical, hybrid, and totally endovascular strategies. Hybrid techniques have the advantage of no chest opening with reduced morbidity, but the problem of the ARSA stump causing recurrent or persistent dysphagia remains challenging in some cases. We conducted a literature review on the management strategies of ARSA and presented the case of a 72-year-old female patient with ARSA and dysphagia managed with thoracic endovascular repair of the aorta (TEVAR) and bilateral carotid-subclavian artery bypass. This technique was chosen because of the severe calcifications at the level of ARSA origin that would make surgical ligation difficult, or if an occluder device not suitable. We think that a patient-tailored approach should be considered in cases of dysphagia lusoria, considering that a multitude of strategies are reported.
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Affiliation(s)
- Ovidiu Stiru
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.S.); (S.-I.B.-T.); (V.A.I.); (C.P.)
- Department of Cardiac Surgery, “Prof. Dr. C. C. Iliescu” Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Mircea Robu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.S.); (S.-I.B.-T.); (V.A.I.); (C.P.)
- Department of Cardiac Surgery, “Prof. Dr. C. C. Iliescu” Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Pavel Platon
- Catheterization Laboratory, “Prof. Dr. C. C. Iliescu” Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania;
| | - Serban-Ion Bubenek-Turconi
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.S.); (S.-I.B.-T.); (V.A.I.); (C.P.)
- 1st Department of Cardiovascular Anesthesiology and Intensive Care, “Prof. Dr. C. C. Iliescu” Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania
| | - Vlad Anton Iliescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.S.); (S.-I.B.-T.); (V.A.I.); (C.P.)
- Department of Cardiac Surgery, “Prof. Dr. C. C. Iliescu” Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Catalina Parasca
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.S.); (S.-I.B.-T.); (V.A.I.); (C.P.)
- Department of Cardiac Surgery, “Prof. Dr. C. C. Iliescu” Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
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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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Zeng Y, Yuan P, He Q. Thoracic endovascular aortic repair for type B aortic dissection with aberrant right subclavian artery: a single-center retrospective study. Front Cardiovasc Med 2023; 10:1277286. [PMID: 38144369 PMCID: PMC10740209 DOI: 10.3389/fcvm.2023.1277286] [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: 08/14/2023] [Accepted: 11/27/2023] [Indexed: 12/26/2023] Open
Abstract
Objective To evaluate the outcomes of thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD) with aberrant right subclavian artery (ARSA). Methods A retrospective analysis was conducted on patients with TBAD and ARSA who underwent TEVAR between the period of January 2017 and December 2022. Patient demographics, computed tomography angiography (CTA) measurements, surgical procedures, and postoperative outcomes were reviewed. Results A total of 9 patients (6 males and 3 females) were included in the study. 4 ARSA were reconstructed, 3 by periscope technique and 1 by in vitro fenestration technique. 3 left subclavian arteries (LSA) were reconstructed, 1 by the chimney technique and 2 by the single-branched stent technique. 2 patients underwent reconstruction of both ARSA and LSA. The overall technical success rate was 100%, with no occurrences of stroke, paraplegia, or mortality within 30 days. 1 patient experienced immediate type Ia endoleak, which resolved after 3 months. 1 patient developed weakness in the right upper limb, while 1 patient presented mild subclavian steal syndrome (SSS); both cases showed recovery during follow-up. The average follow-up duration was 35.6 ± 11.1 months, during which no reinterventions, deaths, or strokes were observed. Conclusion Our limited experience involving 9 patients demonstrates that early and mid-term outcomes of TEVAR for the treatment of TBAD with ARSA are satisfactory.
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Affiliation(s)
- Yanzhang Zeng
- Department of Vascular and Thyroid Surgery, Guizhou Provincial People’s Hospital, Guiyang, China
| | - Ping Yuan
- Department of Vascular and Thyroid Surgery, Guizhou Provincial People’s Hospital, Guiyang, China
| | - Qiang He
- Department of Intervention, Guizhou Provincial People’s Hospital, Guiyang, China
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Ben Ahmed S, Settembre N, Touma J, Brouat A, Favre JP, Jean Baptiste E, Chaufour X, Rosset E. Outcomes in the treatment of aberrant subclavian arteries using the hybrid approach. Interact Cardiovasc Thorac Surg 2022; 35:ivac230. [PMID: 36179094 PMCID: PMC9550270 DOI: 10.1093/icvts/ivac230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/13/2022] [Accepted: 09/29/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES Aberrant subclavian artery (ASCA) occurs rarely but is one of the most frequent anatomical variations of the supra-aortic trunks. No consensus has been established on its best treatment. The goal of this study was to report the outcomes of ASCA treated by the hybrid approach. METHODS This non-interventional retrospective multicentre analysis included patients treated for ASCA by the hybrid approach in 12 French university hospitals between 2007 and 2019. The hybrid approach was defined as an endovascular procedure combined with open surgery or a hybrid stent graft. Patients were divided in 4 groups (from less to more complex treatment). The primary end point was 30-day mortality. The secondary end points were 30-day complications and late mortality. RESULTS This study included 43 patients. The mean age was 65 (SD, standard deviation: 16) years. Symptoms were found in 33 patients. Subclavian revascularization combined with aberrant subclavian artery occlusion was undertaken in 13 patients. Unilateral and bilateral subclavian revascularization combined with a thoracic aortic stent graft was undertaken in 11 and 6 patients, respectively. Total aortic arch repair combined with a thoracic aortic stent graft was undertaken in 13 patients. Thirty-day mortality was 2.3% with a technical success rate of 95.3%. The 30-day major postoperative complication rate was 16.3%: 4 strokes, 2 tamponades, 1 acute respiratory distress syndrome. Mean follow-up was 56.3 (SD: 44.7) months. The late mortality was 18.6%. CONCLUSIONS The ASCA hybrid approach is feasible, safe and effective with low early mortality. Morbidity is rather high. However, it increases with the complexity of the hybrid approach, which should be kept as simple as possible if the anatomical morphology allows.
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Affiliation(s)
- Sabrina Ben Ahmed
- Service de Chirurgie Vasculaire et Cardiovasculaire, CHU Saint-Etienne, Saint-Etienne, France
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, Saint-Etienne, France
| | - Nicla Settembre
- Service de Chirurgie Vasculaire, CHU Nancy, Université de Lorraine, Nancy, France
| | - Joseph Touma
- Service de Chirurgie Vasculaire, CHU Henri Mondor, AP-HP, Créteil, France
| | - Anthony Brouat
- Service de Chirurgie Vasculaire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Jean-Pierre Favre
- Service de Chirurgie Vasculaire et Cardiovasculaire, CHU Saint-Etienne, Saint-Etienne, France
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, Saint-Etienne, France
| | | | - Xavier Chaufour
- Service de Chirurgie Vasculaire, CHU Toulouse, Toulouse, France
| | - Eugenio Rosset
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, Saint-Etienne, France
- Centre Cardio-Thoracique de Monaco, Monaco
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Systematic review and meta-analysis of outcomes after operative treatment of aberrant subclavian artery pathologies and suggested reporting items. Eur J Vasc Endovasc Surg 2022; 63:759-767. [DOI: 10.1016/j.ejvs.2022.02.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 01/31/2022] [Accepted: 02/20/2022] [Indexed: 11/17/2022]
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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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Park KY, Janek KC, Hermsen JL, Anagnostopoulos PV, Le HD. Case report: a step-wise management of concurrent presentation of congenital single lung and aberrant right subclavian artery in an infant girl. J Cardiothorac Surg 2021; 16:143. [PMID: 34034797 PMCID: PMC8146621 DOI: 10.1186/s13019-021-01520-z] [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: 03/07/2021] [Accepted: 05/07/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Congenital single lung (CSL) is a rare condition, and symptomatic patients often present with respiratory distress or recurrent respiratory infection due to mediastinal shift causing vascular or airway compression. Aberrant right subclavian artery (ARSA) is another rare congenital anomality that can lead to tracheal or esophageal compressions. There is only one other case of concurrent presentation of CSL and ARSA reported, which presented unique challenge in surgical management of our patient. Here we present a step-wise, multidisciplinary approach to manage symptomatic CSL and ARSA. Case presentation An infant girl with a prenatal diagnosis of CSL developed worsening stridor and several episodes of respiratory illnesses at 11 months old. Cross-sectional imaging and bronchoscopic evaluation showed moderate to severe distal tracheomalacia with anterior and posterior tracheal compression resulting from severe mediastinal rotation secondary to right-sided CSL. It was determined that her tracheal compression was mainly caused by her aortic arch wrapping around the trachea, with possible additional posterior compression of the esophagus by the ARSA. She first underwent intrathoracic tissue expander placement, which resulted in immediate improvement of tracheal compression. Two days later, she developed symptoms of dysphagia lusoria due to increased posterior compression of her esophagus by the ARSA. She underwent transposition of ARSA to the right common carotid with immediate resolution of dysphagia lusoria. As the patient grew, additional saline was added to the tissue expander due to recurrence in compressive symptoms. Conclusions Concurrent presentation of CSL and ARSA is extremely rare. Asymptomatic CSL and ARSA do not require surgical interventions. However, if symptomatic, it is crucial to involve a multidisciplinary team for surgical planning and to take a step-wise approach as we were able to recognize and address both tracheomalacia and dysphagia lusoria in our patient promptly.
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Affiliation(s)
- Keon Young Park
- Department of Surgery, University of California San Francisco, 400 Parnassus Avenue, San Francisco, CA, USA
| | - Kevin C Janek
- Division of Pediatric Surgery, Department of Surgery, American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, MC 7375, Madison, WI, 53792, USA
| | - Joshua L Hermsen
- Division of Cardiothoracic Surgery, Department of Surgery, American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Petros V Anagnostopoulos
- Division of Cardiothoracic Surgery, Department of Surgery, American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Hau D Le
- Division of Pediatric Surgery, Department of Surgery, American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, MC 7375, Madison, WI, 53792, USA.
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8
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Nakamae K, Azuma T, Yokoi Y, Niinami H. Total endovascular repair of a mycotic thoracic aortic aneurysm in a patient with an aberrant right subclavian artery. Eur J Cardiothorac Surg 2021; 59:914-916. [PMID: 33188682 DOI: 10.1093/ejcts/ezaa357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/28/2020] [Accepted: 08/29/2020] [Indexed: 11/12/2022] Open
Abstract
An aberrant right subclavian artery (ARSA) is a rare arterial anomaly. Although a few cases of total endovascular repair for the ARSA aneurysm have been previously reported, anatomical limitations and the possibility of endoleaks remained. In this case, we created 4 holes on the stent graft for each cervical branch, with reference to the preoperative computed tomography findings. This approach might enable us to repair all types of thoracic aortic aneurysms with ARSA with each anatomical feature.
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Affiliation(s)
- Kosuke Nakamae
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takashi Azuma
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshihiko Yokoi
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroshi Niinami
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
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Singh S, Chen JF, Assi R, Nassiri N, Vallabhajosyula P. Intraoperative retrograde TEVAR to control endoleak after emergent total arch replacement and frozen elephant trunk repair for ruptured Kommerell's diverticulum. J Card Surg 2020; 35:3578-3580. [PMID: 33085131 DOI: 10.1111/jocs.14950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report an emergent complex hybrid repair of a type A intramural hematoma with a tear of the aortic arch at the site of Kommerell's diverticulum and an aberrant right subclavian artery. We identified a type IA endoleak intraoperatively, which was managed immediately with proximal extension. Performing this operation in the hybrid operating room facilitated optimal surgical management.
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Affiliation(s)
- Saket Singh
- Department of Surgery, Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Julia F Chen
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Roland Assi
- Department of Surgery, Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Naiem Nassiri
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Prashanth Vallabhajosyula
- Department of Surgery, Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
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Coşkun E, Altınay L, Tekin A, Tütün U. Aberrant right subclavian artery (arteria lusoria) aneurysm with a Kommerell's diverticulum. J Vasc Bras 2019; 18:e20180091. [PMID: 31236102 PMCID: PMC6579525 DOI: 10.1590/1677-5449.009118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/19/2018] [Indexed: 11/24/2022] Open
Abstract
The treatment options for aberrant right subclavian artery vary depending on the presence of Kommerell’s diverticulum. Because there is a tendency not to report mortalities of these rare cases in the literature, it is hard to reach a conclusion on treatments from the limited data on post-interventional results in these patients. We report our experience with a 67-year old patient with an aberrant right subclavian aneurysm with Kommerell’s diverticulum, diagnosed by chance.
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Affiliation(s)
- Elif Coşkun
- Bulent Ecevit University, Faculty of Medicine, Department of Cardiovascular Surgery, Zonguldak, Turkey
| | - Levent Altınay
- Bulent Ecevit University, Faculty of Medicine, Department of Cardiovascular Surgery, Zonguldak, Turkey
| | - Anıl Tekin
- Bulent Ecevit University, Faculty of Medicine, Department of Cardiovascular Surgery, Zonguldak, Turkey
| | - Ufuk Tütün
- Bulent Ecevit University, Faculty of Medicine, Department of Cardiovascular Surgery, Zonguldak, Turkey
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Jahangeer S, Bashir M, Harky A, Yap J. Aberrant subclavian: new face of an old disease. J Vis Surg 2018; 4:108. [PMID: 29963397 DOI: 10.21037/jovs.2018.05.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 05/04/2018] [Indexed: 01/04/2023]
Abstract
An aneurysm of an aberrant subclavian artery is un usual prevalence of anomalies of aortic arch, with a literature reported prevalence of 2%. Timely elective intervention is of paramount. The advancement in stenting techniques has promoted this practice to be an alternative to conventional open surgical repair which is associated with high rates of perioperative complications including mortality outcomes. However, new faces of this old disease are emerging as we move to novelty and innovation era. We discuss in this review the advancements in this disease entity highlighting and collecting the world experiences.
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Affiliation(s)
- Saleem Jahangeer
- Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Mohamad Bashir
- Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Amer Harky
- Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK.,School of Medicine, Cardiff University, Cardiff, UK
| | - John Yap
- Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
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13
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Gao X, Li L, Gu Y, Guo L, Cui S, Qi L, Li J, Zhang J. Endovascular repair of subclavian artery aneurysms: results from a single-center experience. Perfusion 2017; 32:670-674. [PMID: 28699424 DOI: 10.1177/0267659117720988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To present our experience of the endovascular treatment of subclavian artery aneurysms (SAAs) and analyze the clinical manifestations, imaging findings and treatment outcomes. Methods: In this retrospective study, nine patients with SAAs underwent endovascular stent placement in our center between July 2011 and June 2016. Clinical features, imaging findings, treatment outcomes and follow-up results of these SAA patients were retrospectively analyzed. Results: Nine patients were diagnosed with SAAs by computer tomography angiography (CTA). Five patients underwent percutaneous endovascular stent placement in the subclavian artery. Three patients underwent endovascular repair of the SAAs with coil embolization and stent graft. One patient underwent stent graft implantation by the simultaneous kissing stent technique. Five patients had their symptoms relieved and thrombosis occurred in one case. The mean follow-up period was 17 months, ranging from 8 to 40 months. Conclusion: For patients with SAAs, endovascular treatment is a feasible choice, with a high success rate, few complications and good clinical outcomes.
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Affiliation(s)
- XiXiang Gao
- Department of Vascular Surgery, Xuan Wu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - LiQiang Li
- Department of Vascular Surgery, Xuan Wu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - YongQuan Gu
- Department of Vascular Surgery, Xuan Wu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - LianRui Guo
- Department of Vascular Surgery, Xuan Wu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - ShiJun Cui
- Department of Vascular Surgery, Xuan Wu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - LiXing Qi
- Department of Vascular Surgery, Xuan Wu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - JianXin Li
- Department of Vascular Surgery, Xuan Wu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Jian Zhang
- Department of Vascular Surgery, Xuan Wu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
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Mazzaccaro D, Derosa TM, De Febis E, Righini P, Nano G. Total endovascular repair of aberrant right subclavian artery aneurysm using the periscope technique: a case report. Int J Surg Case Rep 2016; 29:126-129. [PMID: 27842259 PMCID: PMC5109263 DOI: 10.1016/j.ijscr.2016.10.067] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/30/2016] [Indexed: 11/17/2022] Open
Abstract
Aneurysmal aberrant right subclavian arteries (ARSA) have a high risk of rupture. Treatment options include open surgery or hybrid surgical and endovascular repair. The “periscope” technique allows the urgent endovascular repair of aneurysmal ARSA.
Introduction Aneurysmal degeneration of aberrant right subclavian artery (ARSA) carries a relevant risk of rupture. Timely elective treatment is mandatory. Therapeutic options include open surgery repair or hybrid surgical and endovascular repair. Few reports of total endovascular approach repair have been reported. Presentation of the case We report the first case of total endovascular repair of an aneurysmal ARSA using a thoracic aortic endograft with a “periscope” covered stent into the ARSA itself. Discussion The total endovascular approach was considered for patient’s age and her poor compliance to the idea of a surgical revascularization of the ARSA, which has to be preserved since the LSA was diseased. The urgent situation did not allow for the use of a custom-made graft, so the idea of a “periscope” covered graft both to preserve the flow of the ARSA and to exclude the aneurysmal lesion seemed to be the best choice. Conclusion The “periscope” technique allowed the urgent treatment of aneurysmal ARSA with good clinical results.
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Affiliation(s)
| | | | | | - Paolo Righini
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giovanni Nano
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; University of Milan, Milan, Italy
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Chudasama Y, Alcorn J. Dysphagia Lusoria: An Unexpected Sequelum of Cardiothoracic Surgery. Dig Dis Sci 2016; 61:1000-2. [PMID: 26874690 DOI: 10.1007/s10620-015-3994-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 12/09/2015] [Indexed: 12/09/2022]
Affiliation(s)
- Yuvrajsinh Chudasama
- Division of Gastroenterology and Hepatology, University of New Mexico School of Medicine, Albuquerque, NM, USA.
| | - Joseph Alcorn
- Division of Gastroenterology and Hepatology, University of New Mexico School of Medicine, Albuquerque, NM, USA
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Li L, Yu H, Qi Y, Qi L, Li J, Gu Y, Zhang J. Simultaneous Kissing Stent Technique with Stent Grafts for Subclavian Artery Aneurysm: A Case Report. Ann Vasc Surg 2015; 29:1316.e17-9. [DOI: 10.1016/j.avsg.2015.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 02/04/2015] [Accepted: 02/08/2015] [Indexed: 11/29/2022]
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Komooka M, Higashiue S, Kuroyanagi S, Furuya O, Naito S, Kojima S. Hybrid endovascular repair for an arch aneurysm combined with aberrant right subclavian artery. Ann Vasc Dis 2015; 8:59-61. [PMID: 25848437 DOI: 10.3400/avd.cr.14-00123] [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] [Received: 10/23/2014] [Accepted: 01/16/2015] [Indexed: 11/13/2022] Open
Abstract
This report describes a hybrid endovascular approach to a 9.3-cm saccular aneurysm of the left sided aortic arch combined with an aberrant right subclavian artery. The two-step procedure consisted of a bilateral carotid-subclavian bypass, followed by an ascending aorta-bicarotid bypass and completed by an endovascular exclusion of the aneurysm by covering the whole aortic arch and its branches. The patient had no postoperative complications and was discharged 10 postoperative day. Hybrid procedures may be useful in complex aortic arch pathologies and may reduce postoperative complications in comparison with conventional open surgery.
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Affiliation(s)
- Masatoshi Komooka
- Department of cardiovascular surgery, Kishiwada Tokusyukai Hospital, Kishiwada, Osaka, Japan
| | - Shinichi Higashiue
- Department of cardiovascular surgery, Kishiwada Tokusyukai Hospital, Kishiwada, Osaka, Japan
| | - Satoshi Kuroyanagi
- Department of cardiovascular surgery, Kishiwada Tokusyukai Hospital, Kishiwada, Osaka, Japan
| | - Onichi Furuya
- Department of cardiovascular surgery, Kishiwada Tokusyukai Hospital, Kishiwada, Osaka, Japan
| | - Shiho Naito
- Department of cardiovascular surgery, Kishiwada Tokusyukai Hospital, Kishiwada, Osaka, Japan
| | - Saburo Kojima
- Department of cardiovascular surgery, Kishiwada Tokusyukai Hospital, Kishiwada, Osaka, Japan
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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: 137] [Impact Index Per Article: 15.2] [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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Polguj M, Chrzanowski Ł, Kasprzak JD, Stefańczyk L, Topol M, Majos A. The aberrant right subclavian artery (arteria lusoria): the morphological and clinical aspects of one of the most important variations--a systematic study of 141 reports. ScientificWorldJournal 2014; 2014:292734. [PMID: 25105156 PMCID: PMC4102086 DOI: 10.1155/2014/292734] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/22/2014] [Accepted: 05/06/2014] [Indexed: 12/20/2022] Open
Abstract
The most important abnormality of the aortic arch is arguably the presence of an aberrant right subclavian artery (arteria lusoria). If this vessel compresses the adjacent structures, several symptoms may be produced. The aim of the study is to present the morphological and clinical aspects of the aberrant right subclavian artery. Three different databases searched for a review of pertinent literature using strictly predetermined criteria. Of 141 cases, 15 were cadaveric and 126 were clinically documented. The gender distribution of the subjects was 55.3% female and 44.7% male. The mean age of the patients at symptoms onset was 49.9 ± 19.4 years for all patients but 54.0 ± 19.6 years and 44.9 ± 18.1 years for female and male subjects, respectively (P = 0.0061). The most common symptoms in this group were dysphagia (71.2%), dyspnea (18.7%), retrosternal pain (17.0%), cough (7.6%), and weight loss (5.9%). The vascular anomalies coexisting with an arteria lusoria were truncus bicaroticus (19.2%), Kommerell's diverticulum (14.9%), aneurysm of the artery itself (12.8%), and a right sided aortic arch (9.2%). In conclusion, compression of adjacent structures by an aberrant right subclavian artery needs to be differentiated from other conditions presenting dysphagia, dyspnea, retrosternal pain, cough, and weight loss.
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Affiliation(s)
- Michał Polguj
- Department of Angiology, Medical University of Łódź, Narutowicza 60, 90-136 Łódź, Poland
| | - Łukasz Chrzanowski
- Department of Cardiology, Medical University of Łódź, Kniaziewicza 33, 90-153 Łódź, Poland
| | - Jarosław D. Kasprzak
- Department of Cardiology, Medical University of Łódź, Kniaziewicza 33, 90-153 Łódź, Poland
| | - Ludomir Stefańczyk
- Department of Radiology, Medical University of Łódź, Kopcińskiego 22, 90-153 Łódź, Poland
| | - Mirosław Topol
- Department of Normal and Clinical Anatomy, Medical University of Łódź, Narutowicza 60, 90-136 Łódź, Poland
| | - Agata Majos
- Department of Radiological and Isotopic Diagnosis and Therapy, Medical University of Łódź, Żeromskiego 113, 90-549 Łódź, Poland
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Vicente S, Glenck M, Mayer D, Veith FJ, Lachat M, Pecoraro F. Chimney and Periscope Grafts to Facilitate Endovascular Treatment of Aortic Transection in a Patient With Aberrant Right Subclavian Artery. J Endovasc Ther 2014; 21:123-6. [DOI: 10.1583/13-4434r.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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