1
|
Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, Desai ND, Dumfarth J, Elefteriades JA, Etz CD, Kim KM, Kreibich M, Lescan M, Di Marco L, Martens A, Mestres CA, Milojevic M, Nienaber CA, Piffaretti G, Preventza O, Quintana E, Rylski B, Schlett CL, Schoenhoff F, Trimarchi S, Tsagakis K, Siepe M, Estrera AL, Bavaria JE, Pacini D, Okita Y, Evangelista A, Harrington KB, Kachroo P, Hughes GC. EACTS/STS Guidelines for Diagnosing and Treating Acute and Chronic Syndromes of the Aortic Organ. Ann Thorac Surg 2024; 118:5-115. [PMID: 38416090 DOI: 10.1016/j.athoracsur.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Martin Czerny
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany.
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria; Medical Faculty, Sigmund Freud Private University, Vienna, Austria.
| | - Tim Berger
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France; EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy; Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Christian D Etz
- Department of Cardiac Surgery, University Medicine Rostock, University of Rostock, Rostock, Germany
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, Texas
| | - Maximilian Kreibich
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Luca Di Marco
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andreas Martens
- Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany; The Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Christoph A Nienaber
- Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Gabriele Piffaretti
- Vascular Surgery Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Bartosz Rylski
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Santi Trimarchi
- Department of Cardiac Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Medicine Essen, Essen, Germany
| | - Matthias Siepe
- EACTS Review Coordinator; Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Anthony L Estrera
- STS Review Coordinator; Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston, Houston, Texas
| | - Joseph E Bavaria
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Davide Pacini
- Division of Cardiac Surgery, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Yutaka Okita
- Cardio-Aortic Center, Takatsuki General Hospital, Osaka, Japan
| | - Arturo Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Instituto del Corazón, Quirónsalud-Teknon, Barcelona, Spain
| | - Katherine B Harrington
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Puja Kachroo
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Duke University, Durham, North Carolina
| |
Collapse
|
2
|
Nishio H, Iwakura A, Takahashi N, Aida K, Inoue K, Takai F, Ishigami M, Yukawa H, Sakaguchi H, Fukushima T, Hayashi F. Right Carotid Artery Origin Compression Caused by Endovascular Repair for Kommerell Diverticulum Associated with a Right-Sided Aortic Arch. Ann Vasc Dis 2024; 17:201-204. [PMID: 38919326 PMCID: PMC11196165 DOI: 10.3400/avd.cr.24-00002] [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: 01/15/2024] [Accepted: 03/15/2024] [Indexed: 06/27/2024] Open
Abstract
Owing to the unique anatomical features, the endovascular repair for Kommerell diverticulum poses a surgical challenge. An 80-year-old, asymptomatic female with Kommerell diverticulum and associated right-sided aortic arch underwent an endovascular repair, consisting of an aortic arch endografting with a proximal extension, axillo-axillary crossover bypass, and right subclavian parallel endografting. An additional stent was promptly placed retrogradely at the right carotid artery origin as the completion aortography revealed an ostial occlusion. During the 6th month follow-up, she remained well without any neurological deficits. This report elucidated the disease-specific and procedure-related causes leading to right carotid artery ostium occlusion.
Collapse
Affiliation(s)
- Hiroomi Nishio
- Department of Cardiovascular Surgery, Osaka Red Cross Hospital, Osaka, Osaka, Japan
| | - Atsushi Iwakura
- Department of Cardiovascular Surgery, Osaka Red Cross Hospital, Osaka, Osaka, Japan
| | - Naoki Takahashi
- Department of Cardiology, Osaka Red Cross Hospital, Osaka, Osaka, Japan
| | - Kenji Aida
- Department of Cardiology, Osaka Red Cross Hospital, Osaka, Osaka, Japan
| | - Kyozo Inoue
- Department of Cardiovascular Surgery, Yodogawa Christian Hospital, Osaka, Osaka, Japan
| | - Fumie Takai
- Department of Cardiovascular Surgery, Osaka Red Cross Hospital, Osaka, Osaka, Japan
| | - Masanosuke Ishigami
- Department of Cardiovascular Surgery, Osaka Red Cross Hospital, Osaka, Osaka, Japan
| | - Hiroshi Yukawa
- Department of Cardiology, Osaka Red Cross Hospital, Osaka, Osaka, Japan
| | - Hisashi Sakaguchi
- Department of Cardiovascular Surgery, Osaka Red Cross Hospital, Osaka, Osaka, Japan
| | - Takashi Fukushima
- Department of Cardiovascular Surgery, Osaka Red Cross Hospital, Osaka, Osaka, Japan
| | - Fujio Hayashi
- Department of Cardiology, Osaka Red Cross Hospital, Osaka, Osaka, Japan
| |
Collapse
|
3
|
Hu B, Li J, Li L, Yin H, Zheng C, Fan L. Neuro-Interventional Diagnosis and Treatment Using the Right Transradial Approach in Patients with Aberrant Right Subclavian Artery. World Neurosurg 2024; 185:e1330-e1337. [PMID: 38521216 DOI: 10.1016/j.wneu.2024.03.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/17/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE To assess the effectiveness and safety of neurological interventions using the right transradial approach (R-TRA) in patients with aberrant right subclavian artery (ARSA). METHODS We retrospectively analyzed cases that underwent cerebral angiography and interventions at Huangpi District People's Hospital from January 2023 to July 2023. Out of 335 cases, 5 patients with ARSA were identified. RESULTS All 5 cases underwent diagnostic cerebral angiography via R-TRA. Two of the patients received interventions via R-TRA: 1 underwent right internal carotid artery balloon dilation angioplasty, while another underwent left vertebral artery stenting. No surgery-related complications were observed during these procedures. CONCLUSIONS R-TRA proves to be a safe and effective option for neuro-interventional surgery in patients with ARSA.
Collapse
Affiliation(s)
- Bin Hu
- Department of Neurology, Huangpi District People's Hospital affiliated to Jianghan University, Wuhan, P.R. China
| | - Jing Li
- Department of Neurology, Huangpi District People's Hospital affiliated to Jianghan University, Wuhan, P.R. China.
| | - Liang Li
- Department of Neurology, Huangpi District People's Hospital affiliated to Jianghan University, Wuhan, P.R. China
| | - Hao Yin
- Department of Neurology, Huangpi District People's Hospital affiliated to Jianghan University, Wuhan, P.R. China
| | - Chong Zheng
- Department of Neurology, Huangpi District People's Hospital affiliated to Jianghan University, Wuhan, P.R. China
| | - Liu Fan
- Department of Neurology, Huangpi District People's Hospital affiliated to Jianghan University, Wuhan, P.R. China
| |
Collapse
|
4
|
Valenzuela-Fuenzalida JJ, Orellana-Donoso M, Perez-Jiménez D, Farfán-Cabello E, Gold-Semmler M, Becerra-Farfan A, Román C, Nova-Baeza P. Systematic review and meta-analysis of right subclavian artery variants and their correlation with cervical-thoracic clinical conditions. Medicine (Baltimore) 2024; 103:e36856. [PMID: 38394517 PMCID: PMC11309723 DOI: 10.1097/md.0000000000036856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/13/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND A high incidence of anatomical variations in the origin of the branches of the aortic arch has been reported, Nowadays, this variation is considered the most frequent in the aortic arch, its prevalence being estimated between 0.5% and 2.5% of the population. To understand its origin, knowledge of embryonic development is necessary. METHODS We searched the MEDLINE, Scopus, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature, and Latin-American literature and caribean of health sciences databases with dates ranging from their inception to June 2023. Study selection, data extraction, and methodological quality were assessed with the guaranteed tool for anatomical studies (Anatomical Quality Assurance). Finally, the pooled prevalence was estimated using a random effects model. RESULTS Thirty-nine studies were found that met the eligibility criteria. Twenty studies with a total of 41,178 subjects were included in the analysis. The overall prevalence of an ARSA variant was 1% (95% confidence interval = 1%-2%), the clinical findings found are that if ARSA is symptomatic it could produce changes in the hemodynamic function of the thoracocervical region in addition to other associated symptomatic complications in surrounding structures. CONCLUSIONS ARSA can cause several types of alterations in the cervical or thoracic region, resulting in various clinical complications, such as lusory dysphagia. Hence, knowing this variant is extremely important for surgeons, especially those who treat the cervico-thoracic region. The low prevalence of ARSA means that many professionals are completely unaware of its existence and possible course and origin. Therefore, this study provides detailed knowledge of ARSA so that professionals can make better diagnoses and treatment of ARSA.
Collapse
Affiliation(s)
- Juan José Valenzuela-Fuenzalida
- Department of Morphology, Faculty of Medicine, Universidad Andrés Bello, Santiago, Chile
- Department of Morphology and Function, Faculty of Health, University of the Americas Santiago, Chile
| | - Mathias Orellana-Donoso
- Department of Morphology, Faculty of Medicine, Universidad Andrés Bello, Santiago, Chile
- Escuela de Medicina, Universidad Finis Terrae, Santiago, Chile
| | - Daniela Perez-Jiménez
- Department of Morphology and Function, Faculty of Health, University of the Americas Santiago, Chile
| | - Emilio Farfán-Cabello
- Departamento de Anatomía, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marjorie Gold-Semmler
- Department of Morphology, Faculty of Medicine, Universidad Andrés Bello, Santiago, Chile
| | - Alvaro Becerra-Farfan
- Departamento de Ciencias Química y Biológicas Facultad de Ciencias de la Salud, Universidad Bernardo O’Higgins
| | - Camila Román
- Department of Morphology, Faculty of Medicine, Universidad Andrés Bello, Santiago, Chile
| | - Pablo Nova-Baeza
- Department of Morphology, Faculty of Medicine, Universidad Andrés Bello, Santiago, Chile
| |
Collapse
|
5
|
Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, Desai ND, Dumfarth J, Elefteriades JA, Etz CD, Kim KM, Kreibich M, Lescan M, Di Marco L, Martens A, Mestres CA, Milojevic M, Nienaber CA, Piffaretti G, Preventza O, Quintana E, Rylski B, Schlett CL, Schoenhoff F, Trimarchi S, Tsagakis K. EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ. Eur J Cardiothorac Surg 2024; 65:ezad426. [PMID: 38408364 DOI: 10.1093/ejcts/ezad426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/15/2023] [Accepted: 12/19/2023] [Indexed: 02/28/2024] Open
Affiliation(s)
- Martin Czerny
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria
- Medical Faculty, Sigmund Freud Private University, Vienna, Austria
| | - Tim Berger
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France
- EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
- Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Christian D Etz
- Department of Cardiac Surgery, University Medicine Rostock, University of Rostock, Rostock, Germany
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, TX, USA
| | - Maximilian Kreibich
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Luca Di Marco
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andreas Martens
- Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany
- The Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Christoph A Nienaber
- Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Gabriele Piffaretti
- Vascular Surgery Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Bartosz Rylski
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Santi Trimarchi
- Department of Cardiac Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Medicine Essen, Essen, Germany
| |
Collapse
|
6
|
Nguyen D, Leon LR, Berman SS. Hybrid repair of aberrant right subclavian artery using open and endovascular techniques. J Vasc Surg Cases Innov Tech 2023; 9:101307. [PMID: 37771729 PMCID: PMC10522982 DOI: 10.1016/j.jvscit.2023.101307] [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: 06/17/2023] [Accepted: 08/09/2023] [Indexed: 09/30/2023] Open
Abstract
An aberrant right subclavian artery, the most common anatomic variant of the aortic arch, occurs in 0.5% of the population. Symptoms generally result from compression of the esophagus and/or trachea as the aberrant vessel passes posteriorly in the mediastinum. Treatment includes revascularization of the right subclavian artery from the right common carotid artery using a cervical approach combined with occlusion of the origin of the aberrant vessel from the thoracic aorta. We describe a hybrid treatment approach for a symptomatic aberrant right subclavian artery using cervical revascularization and branched thoracic stent graft coverage of the origin of the aberrant vessel.
Collapse
Affiliation(s)
- Daniel Nguyen
- College of Medicine, The University of Arizona, Tucson, AZ
| | - Luis R. Leon
- Pima Heart and Vascular, Tucson, AZ
- Section of Vascular Surgery, The University of Arizona, Tucson, AZ
| | - Scott S. Berman
- Pima Heart and Vascular, Tucson, AZ
- Section of Vascular Surgery, The University of Arizona, Tucson, AZ
| |
Collapse
|
7
|
Akbulut M, Celik EC, Ak A, Arslan Ö, Çekmecelioğlu D, Şişmanoğlu M, Tunçer MA. Management of complex thoracic aortic diseases with aberrant right subclavian artery. Vascular 2023:17085381231217059. [PMID: 37978808 DOI: 10.1177/17085381231217059] [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: 11/19/2023]
Abstract
BACKGROUND We retrospectively evaluated early and intermediate outcomes of hybrid repair of complex thoracic aortic diseases involving an aberrant right subclavian artery. This paper aims to report features and available treatment options for this rare, hard-to-diagnose, and manage, aorta-related vascular condition. METHODS Between January 2012 and May 2019, 13 patients (mean age, 60.1 ± 9.3 years; nine men) underwent complex thoracic aorta repair surgery. Six patients had a thoracic aortic aneurysm, two had type A aortic dissection, and five had complicated type B aortic dissection. Hybrid repair strategies included de-branching in combination with single-stage aortic arch replacement with the frozen elephant trunk technique performed in four patients, thoracic endovascular aortic repair in six patients, and 2-stage hybrid repair consisting of a total arch replacement with a conventional/frozen elephant trunk (first stage) and subsequent endovascular repair (second stage) in three patients. RESULTS One early death occurred: a patient with acute type A aortic dissection, who underwent Bentall procedure and aortic arch replacement with the frozen elephant trunk technique, died in-hospital of multiorgan failure 41 days after the procedure. The remaining 12 patients were discharged in stable condition. The median follow-up duration was 36 months (2-71 months). Two late mortalities occurred: a patient with residual type A aortic dissection, who underwent arch replacement with the frozen elephant trunk technique, died of intracranial hemorrhage 3 months after the surgery. And 72 years old female patient died of acute exacerbation of chronic obstructive pulmonary disease 2 months after the surgery. CONCLUSION Our study indicates that various hybrid strategies can be used to treat complex thoracic aortic diseases involving an aberrant right subclavian artery. The approach of choice depends on the features of disease pathology, the aortic segments involved, and the operating surgeon's experience.
Collapse
Affiliation(s)
- Mustafa Akbulut
- Department of Cardiovascular Surgery, Koşuyolu High Specialization Education and Research Hospital, Istanbul, Turkey
| | - Ekin C Celik
- Department of Cardiovascular Surgery, Antalya Education and Research Hospital, Antalya, Turkey
| | - Adnan Ak
- Department of Cardiovascular Surgery, Koşuyolu High Specialization Education and Research Hospital, Istanbul, Turkey
| | - Özgür Arslan
- Department of Cardiovascular Surgery, Koşuyolu High Specialization Education and Research Hospital, Istanbul, Turkey
| | - Davut Çekmecelioğlu
- Department of Cardiothoracic Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mesut Şişmanoğlu
- Department of Cardiovascular Surgery, Koşuyolu High Specialization Education and Research Hospital, Istanbul, Turkey
| | - Mehmet A Tunçer
- Department of Cardiovascular Surgery, İstanbul Okan University Hospital, Istanbul, Turkey
| |
Collapse
|
8
|
Solano A, Pizano A, Azam J, Gonzalez-Guardiola G, Siah M, Chamseddin K, Prakash V, Kirkwood ML, Shih M. Kommerell's Diverticulum in a Right-Sided Aortic Arch With an Aberrant Left Subclavian Artery Hybrid Repair. Vasc Endovascular Surg 2023; 57:954-959. [PMID: 37310394 PMCID: PMC10543133 DOI: 10.1177/15385744231183310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Kommerell's diverticulum (KD) with a right aortic arch (RAA) and aberrant left subclavian artery (aLSCA) is a rare congenital anomaly of the aortic arch. Treatment is not well defined due to its uncommon presentation, with rupture and dissection risk rates of up to 53%. CASE SUMMARY A 54-year-old male with a history of chronic obstructive pulmonary disease (COPD) and hypertension presented with difficulty breathing during exercise without dysphagia. Follow-up computerized tomography angiogram (CTA) revealed the presence of a RAA and aLSCA arising from the descending thoracic aorta with an adjacent 58 × 41-mm KD and tracheal and esophageal displacement. Due to the size of the KD, risk of rupture, unsuitable anatomy for total endovascular aortic repair (EVAR), and high COPD burden, the patient was planned to undergo a hybrid surgical repair. Left common carotid (LCCA) artery to LSCA bypass, full aortic debranching, LSCA embolization and percutaneous thoracic endovascular aortic repair (TEVAR) were performed. Successful device position and exclusion of the diverticulum and aneurysmal aorta were observed after completion thoracic aortogram. 18-month follow-up CTA demonstrated patency of the LSCA to LCCA bypass graft and arch vessel branches, as well as stable exclusion of the KD. Persistence of a type II endoleak originated at the right first posterior intercostal artery has been noted and is being followed conservatively since no sac growth has occurred. CONCLUSION We highlight the presence of a KD with RAA and aberrant subclavian artery, a rare congenital anatomic variation of the aortic arch with complex anatomy. Surgical planning must be individualized according to comorbidities and anatomical variations identified on imaging and 3D reconstructions.
Collapse
Affiliation(s)
- Antonio Solano
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
| | - Alejandro Pizano
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
| | - Jawaher Azam
- Medical School, University of Texas Southwestern Medical Center, Dallas, TX, USA Presented at the poster session of the Critical Issues America Annual Meeting. Miami, FL, February 10-11, 2023
| | - Gerardo Gonzalez-Guardiola
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
| | - Michael Siah
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
| | - Khalil Chamseddin
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
| | - Vivek Prakash
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
| | - Melissa L. Kirkwood
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
| | - Michael Shih
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
| |
Collapse
|
9
|
Kimyaghalam A, Gabay A, Singh K. Aberrant right subclavian artery: a case of vertebrobasilar insufficiency. J Surg Case Rep 2023; 2023:rjad199. [PMID: 37114086 PMCID: PMC10125837 DOI: 10.1093/jscr/rjad199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
Aberrant right subclavian artery (ARSA) is a rare congenital malformation, wherein the aorta gives rise to the right subclavian artery as a branch off the aortic arch distal to the takeoff of the left subclavian artery. We presented a case of a patient with ARSA that manifested vertebrobasilar symptoms. PubMed search was preformed using keywords 'aberrant right subclavian artery', 'right subclavian steal' and 'vertebrobasilar', which generated nine articles. We found only seven case reports through a PubMed search that discuss ARSA in association with Subclavian steal syndrome. Approximately 71% (n = 5) of the patients in our literature review manifested with signs and symptoms of vertebrobasilar insufficiency. Given the complex anatomy in this condition, treatment should be aimed at symptom resolution. Carotid-subclavian bypass ultimately resolved the symptoms in our patient. Management in symptomatic patient is surgical. In addition to open technique, endovascular interventions can be an option.
Collapse
Affiliation(s)
- A Kimyaghalam
- Correspondence address. Department of Vascular Surgery, Staten Island University Hospital, Northwell Health, 475 Seaview Ave., Staten Island, NY 10305, USA. Tel: 718-226-8000; Fax: 718-226-6800; E-mail:
| | - A Gabay
- Main Line Health, Philadelphia, PA, USA
| | - K Singh
- Department of Vascular Surgery, State Island University Hospital, Staten Island, NY 10305, USA
| |
Collapse
|
10
|
Olson CG, Cortés P, Stancampiano FF, Valery JR, Bi Y, Pocchetino A, Harris DM. Diagnosis, symptoms, and treatment knowledge of aberrant right subclavian artery in followers of a social media group. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2023; 61:3-5. [PMID: 36278963 DOI: 10.2478/rjim-2022-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Caroline G Olson
- Division of Internal Medicine, Mayo Clinic Jacksonville, FL 32224
| | - Pedro Cortés
- Division of Internal Medicine, Mayo Clinic Jacksonville, FL 32224
| | | | - Jose R Valery
- Division of Internal Medicine, Mayo Clinic Jacksonville, FL 32224
| | - Yan Bi
- Division of Gastroenterology and Hepatology, Mayo Clinic Jacksonville, FL 32224
| | | | - Dana M Harris
- Division of Internal Medicine, Mayo Clinic Jacksonville, FL 32224
| |
Collapse
|
11
|
Lombardi F, Mamopoulos A, Benedik J, Katoh M, Kröger K, Gäbel G. How to Treat Type B Aortic Dissections in the Presence of an Aberrant Right Subclavian Artery: A Systematic Review. AORTA (STAMFORD, CONN.) 2023; 11:20-28. [PMID: 36848908 PMCID: PMC9970753 DOI: 10.1055/s-0042-1757948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 07/06/2022] [Indexed: 06/18/2023]
Abstract
An aberrant right subclavian artery (ARSA) is the most common congenital variant of the aortic arch. Usually, this variation is largely asymptomatic, but sometimes it may be involved in aortic dissection (AD). Surgical management of this condition is challenging. The therapeutic options have been enriched in recent decades by establishing individualized endovascular or hybrid procedures. Whether these less invasive approaches bear advantages, and how they have changed the treatment of this rare pathology, is still unclear. Therefore, we conducted a systematic review. We performed a review of literature from the past 20 years (from January 2000 until February 2021) complying with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. All reported patients treated for Type B AD in the presence of an ARSA were identified and classified into three groups according to the received therapy (open, hybrid, and total endovascular). Patient characteristics, as well as in-hospital mortality, and major and minor complications were determined and statistically analyzed. We identified 32 relevant publications comprising 85 patients. Open arch repair has been offered to younger patients, but significantly less often in symptomatic patients needing urgent repair. Therefore, the maximum aortic diameter was also significantly larger in the open repair group compared with that in the hybrid or total endovascular repair group. Regarding the endpoints, we did not find significant differences. The literature review revealed that open surgical therapies are preferred in patients presenting with chronic dissections and larger aortic diameters, most likely because they are unsuitable for endovascular aortic repair. Hybrid and total endovascular approaches are more often applied in emergency situations, where aortic diameters remain smaller. All therapies demonstrated good, early, and midterm outcomes. But, these therapies carry potential risks in the long term. Therefore, long-term follow-up data are urgently needed to validate that these therapies are sustainable.
Collapse
Affiliation(s)
| | | | | | - Marcus Katoh
- Department of Diagnostic and Interventional Radiology, Helios Clinic, Krefeld, Germany
| | - Knut Kröger
- Department of Vascular Medicine, Helios Clinic, Krefeld, Germany
| | - Gabor Gäbel
- Department of Vascular Surgery, Helios Clinic, Krefeld, Germany
| |
Collapse
|
12
|
A systematic review of open, hybrid, and endovascular repair of aberrant subclavian artery and Kommerell's diverticulum treatment. J Vasc Surg 2023; 77:642-649.e4. [PMID: 35850164 DOI: 10.1016/j.jvs.2022.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/16/2022] [Accepted: 07/07/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Aberrant subclavian artery (AScA) with or without associated Kommerell's diverticulum (KD) is the most frequently encountered anomaly of the aortic arch, it may be life threatening, especially when associated with aneurysmal degeneration. The best management is still debated and depends on many clinical and anatomical factors. A systematic review was conducted to assess the current evidence on the treatment options and their efficacy and safety for AscA and KD repairs. METHODS A literature search in PubMed and Cochrane Library was performed, and articles that were published from January 1947 to August 2021 reporting on AscA and KD management were identified. Multicenter studies, single-center series, and case series with three or more patients were considered eligible in the present review. A comparison of outcomes of patients who underwent open surgery (OS), a hybrid approach (HA), and total endovascular repair (ER) (ie, 30-day mortality and stroke were analyzed when available and compared among the three groups (P < .05; Benjamini and Hochberg-adjusted P < .05; Bonferroni-adjusted P < .05). Titles, abstracts, and full texts were evaluated by two authors independently. Primary outcomes included survival rate, perioperative stroke, arm ischemia, and spinal cord ischemia. Endoleak, in the case of HA and ER, and reintervention rates were considered outcomes. RESULTS Three hundred thirty-one articles were initially evaluated and 30 studies, totaling 426 patients treated for AScA with 324 KD, were included. Of the 426 patients, 241 were male (56.5%), and the mean patient age was 57.9 ± 12.0 years. The approach was OS in 228 patients, HA in 147 patients, and ER in 51. Dysphagia was the most common presentation in 133 cases. Aortic rupture was observed in 16 of the 426 patients (3.8%), including 14 AScA/KD (3.3%) aneurysm rupture. KD maximum diameter varied widely from 12.6 to 63.6 mm. The overall 30-day mortality was 20 (4.7%) (OS group 8/228 [3.5%]; HA group 10/147 [6.8%]; ER 2/51 [3.9%]; P = NS). The overall stroke rate was 4.9% (21/426) (OS group 10/228 [4.4%]; HA group 6/147 [4.1%]; ER group 5/51 [9.8%]; P = NS), including nine transient and nondisabling neurological deficits. Overall secondary procedures for complications were reported in 36 of the 426 cases (8.4%), mostly owing to endoleak. Follow-up varied from 13 to 74 months. CONCLUSIONS This systematic review assessed the current outcomes of the three types of therapeutic management for AScA and KD and demonstrated that they are all relatively safe and effective, providing satisfactory early and midterm outcomes. Long-term outcomes are warranted, especially for total ERs since the long-term durability of stent grafts remains unknown.
Collapse
|
13
|
Clinical Characteristics and Computed Tomography Findings in Adult Patients With an Aberrant Right Subclavian Artery: A Single-Center Retrospective Cohort Study. J Comput Assist Tomogr 2023; 47:382-389. [PMID: 36728158 DOI: 10.1097/rct.0000000000001435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We sought to determine the prevalence and possible features associated with symptoms in adult patients diagnosed with an aberrant right subclavian artery (ARSA). METHODS In this single-center retrospective study, 386 adult patients were diagnosed with ARSA on chest CT scans performed between June 2016 and April 2021. Patients were grouped by the presence of symptoms, which included dysphagia, shortness of breath, cough, and upper airway wheezing. Four cardiothoracic radiologists reviewed the chest CT scans to assess features of ARSA. Agreement and multivariable logistic regression analyses were performed to determine interobserver variability and features associated with the presence of symptoms, respectively. RESULTS The prevalence of ARSA was 1.02% and 81.3% of patients were asymptomatic. Shortness of breath (74.6%) was the most common symptom. Interobserver agreement was acceptable with most variables having an interclass correlation coefficient or κ >0.80. A patient's height > 158 cm (OR: 2.50, P = 0.03), cross-sectional area > 60 mm2 of ARSA at the level of the esophagus (OR: 2.39, P = 0.046), and angle >108 degrees formed with the aortic arch (OR: 1.99, P = 0.03) were associated with the presence of symptoms on multivariable logistic regression. A distance increase per 1 mm between ARSA and trachea (OR: 0.85, P = 0.02) was associated with decreased odds of symptoms. CONCLUSIONS Aberrant right subclavian artery is an incidental finding in most adult patients. The cross-sectional area at the level of the esophagus, angle formed with the medial wall of the aortic arch, distance between the ARSA and the trachea, and a patient's height were features associated with the presence of symptoms.
Collapse
|
14
|
Contemporary outcomes after treatment of aberrant subclavian artery and Kommerell's diverticulum. J Vasc Surg 2023; 77:1339-1348.e6. [PMID: 36657501 DOI: 10.1016/j.jvs.2023.01.014] [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: 10/28/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Aberrant subclavian artery (ASA) and Kommerell's diverticulum (KD) are rare vascular anomalies that may be associated with lifestyle-limiting and life-threatening complications. The aim of this study is to report contemporary outcomes after invasive treatment of ASA/KD using a large international dataset. METHODS Patients who underwent treatment for ASA/KD (2000-2020) were identified through the Vascular Low Frequency Disease Consortium, a multi-institutional collaboration to investigate uncommon vascular disorders. We report the early and mid-term clinical outcomes including stroke and mortality, technical success, and other operative outcomes including reintervention rates, patency, and endoleak. RESULTS Overall, 285 patients were identified during the study period. The mean patient age was 57 years; 47% were female and 68% presented with symptoms. A right-sided arch was present in 23%. The mean KD diameter was 47.4 mm (range, 13.0-108.0 mm). The most common indication for treatment was symptoms (59%), followed by aneurysm size (38%). The most common symptom reported was dysphagia (44%). A ruptured KD was treated in 4.2% of cases, with a mean diameter of 43.9 mm (range, 18.0-100.0 mm). An open procedure was performed in 101 cases (36%); the most common approach was ASA ligation with subclavian transposition. An endovascular or hybrid approach was performed in 184 patients (64%); the most common approach was thoracic endograft and carotid-subclavian bypass. A staged operative strategy was employed more often than single setting repair (55% vs 45%). Compared with endovascular or hybrid approach, those in the open procedure group were more likely to be younger (49 years vs 61 years; P < .0001), female (64% vs 36%; P < .0001), and symptomatic (85% vs 59%; P < .0001). Complete or partial symptomatic relief at 1 year after intervention was 82.6%. There was no association between modality of treatment and symptom relief (open 87.2% vs endovascular or hybrid approach 78.9%; P = .13). After the intervention, 11 subclavian occlusions (4.5%) occurred; 3 were successfully thrombectomized resulting in a primary and secondary patency of 95% and 96%, respectively, at a median follow-up of 39 months. Among the 33 reinterventions (12%), the majority were performed for endoleak (36%), and more reinterventions occurred in the endovascular or hybrid approach than open procedure group (15% vs 6%; P = .02). The overall survival rate was 87.3% at a median follow-up of 41 months. The 30-day stroke and death rates were 4.2% and 4.9%, respectively. Urgent or emergent presentation was independently associated with increased risk of 30-day mortality (odds ratio [OR], 19.8; 95% confidence interval [CI], 3.3-116.6), overall mortality (OR, 3.6; 95% CI, 1.2-11.2) and intraoperative complications (OR, 8.3; 95% CI, 2.8-25.1). Females had a higher risk of reintervention (OR, 2.6; 95% CI, 1.0-6.5). At an aneurysm size of 44.4 mm, receiver operator characteristic curve analysis suggested that 60% of patients would have symptoms. CONCLUSIONS Treatment of ASA/KD can be performed safely with low rates of mortality, stroke and reintervention and high rates of symptomatic relief, regardless of the repair strategy. Symptomatic and urgent operations were associated with worse outcomes in general, and female gender was associated with a higher likelihood of reintervention. Given the worse overall outcomes when symptomatic and the inherent risk of rupture, consideration of repair at 40 mm is reasonable in most patients. ASA/KD can be repaired in asymptomatic patients with excellent outcomes and young healthy patients may be considered better candidates for open approaches versus endovascular or hybrid modalities, given the lower likelihood of reintervention and lower early mortality rate.
Collapse
|
15
|
Zalle I, Zouche ZM, d'Ostrevy N, Pujos CH, Sawadogo A, Chabrot P, Boyer L, Camilleri L. Endovascular Treatment with Arch Vessel Reconstruction on Patients with Kommerell Diverticulum and Aberrant Left Subclavian Artery. J Vasc Interv Radiol 2022; 33:1527-1530. [PMID: 35998802 DOI: 10.1016/j.jvir.2022.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/21/2022] [Accepted: 08/14/2022] [Indexed: 10/15/2022] Open
Abstract
No guidelines for the treatment of Kommerell diverticulum (KD) have been established. Endovascular treatment with arch vessel reconstruction of 4 patients with a right-sided aortic arch and aberrant left subclavian artery are presented herein. A 39-year-old woman and 47-year-old man experienced dyspnea and retrosternal pain. The first patient concomitantly underwent left subclavian transposition and thoracic endovascular aortic repair (TEVAR). The second patient underwent bilateral carotid-subclavian bypass grafting, followed by TEVAR and KD embolization. The 2 other patients were 72- and 75-year old men who presented with KD and type B dissection, in which these conditions were characterized by acute thoracic pain in the former patient and were noted on incidental body scan for prostatic adenocarcinoma in the latter. The third patient underwent carotid-subclavian bypass grafting, followed by TEVAR and subclavian plugs, and in the fourth patient, regular follow-up with antihypertensive therapy was scheduled. After a mean follow-up period of 12 months, all patients were alive.
Collapse
Affiliation(s)
- Issaka Zalle
- Department of Cardiac Surgery, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Zied M Zouche
- Department of Radiology, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Nicolas d'Ostrevy
- Department of Cardiac Surgery, Gabriel Montpied University Hospital, Clermont-Ferrand, France; ISIT UMR 6284 CNRS, Faculté de médecine, Université d'Auvergne, Clermont-Ferrand, France
| | - Charline H Pujos
- Department of Cardiac Surgery, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Adama Sawadogo
- Department of Cardiac Surgery, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Pascal Chabrot
- Department of Radiology, Gabriel Montpied University Hospital, Clermont-Ferrand, France; ISIT UMR 6284 CNRS, Faculté de médecine, Université d'Auvergne, Clermont-Ferrand, France
| | - Louis Boyer
- Department of Radiology, Gabriel Montpied University Hospital, Clermont-Ferrand, France; ISIT UMR 6284 CNRS, Faculté de médecine, Université d'Auvergne, Clermont-Ferrand, France
| | - Lionel Camilleri
- Department of Cardiac Surgery, Gabriel Montpied University Hospital, Clermont-Ferrand, France; ISIT UMR 6284 CNRS, Faculté de médecine, Université d'Auvergne, Clermont-Ferrand, France.
| |
Collapse
|
16
|
Lin R, Jiang R, Wang S, Zheng J, Sun Y, Xue Y, Huang X. Alterations of Arterial Morphology in Aberrant Subclavian Artery Patients with Type B Dissection and its Association with Dissection. J Vasc Surg 2022; 76:891-898.e2. [PMID: 35753651 DOI: 10.1016/j.jvs.2022.06.021] [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: 02/27/2022] [Revised: 05/13/2022] [Accepted: 06/03/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The arterial morphology in aberrant subclavian artery (ASA) patients and its association with type B aortic dissection are important for treatment and prevention. This study examined the arterial morphology of ASA patients with type B dissection and evaluated its association with type B dissection in vivo. METHODS The presence of ASA and type B dissection was screened from patients with aortic dissection receiving computed tomography angiography (CTA) from January 2011 to May 2021. ASA patients with type B dissection (Group 1, n=16), clinically-matched counterparts without type B dissection (Group 2, n=32) and clinically-matched type B dissection subjects without ASA (Group 3, n=32) were measured for the angles of ascending aorta, aortic arch, aortic deviation, and the diameters of ascending aorta, aortic arch, ASA ostium and middle ASA segment. The correlation between ASA morphology and type B dissection was analyzed by variance analysis or Wallies H test. RESULTS Compared with Group 2, Group 1 reported a sharper ascending aortic angle (131.5o±13.7o vs. 148.1o±7.8o, P=0.001), larger aortic deviation angle in plane 2 (28.2o±6.0o vs. 22.1o±7.2o, P=0.005) and plane 3 (26.4 o±7.3o vs. 21.8o±6.3o, P=0.028). Similarly, Group 1 displayed a greater diameter in the ascending aorta, aortic arch, and the ostium and middle of ASA (38.3±4.1mm vs. 33.6±4.5mm, P=0.001; 34.0±9.3mm vs. 26.2±2.9mm, P=0.004; 20.3±9.3mm vs. 14.0±3.2mm, P=0.018; 10.8±2.3mm vs. 9.0±1.5mm, P=0.002, respectively), without a significant difference in the aortic arch angle. Compared with Group 3, Group 1 showed a sharper ascending aortic angle (131.5o±13.7o vs. 142.5o±11.7o, P=0.026) and smaller aortic deviation angle in plane 1 (21.7o±6.2o vs. 28.9o±6.2o, P=0.04) and plane 3 (26.4o±7.3o vs. 21.8o±6.3o, P=0.007), though with no significant difference in the aortic arch angle, aortic deviation angle in plane 2, and ascending aortic diameter. CONCLUSIONS The diameters of the ostium and middle segment of ASA and ascending aorta and the angles of ascending aorta and aortic deviation are potential risk factors for type B dissection in ASA patients, which may provide new insights into the mechanism of type B dissection in patients with ASA.
Collapse
Affiliation(s)
- Ruolan Lin
- Department of Radiology, Fujian Medical University Union Hospital, Fujian, China
| | - Rifeng Jiang
- Department of Radiology, Fujian Medical University Union Hospital, Fujian, China
| | - Shu Wang
- School of Mechanical Engineering and Automation, Fuzhou University, Fuzhou 350108, China
| | - Jinmei Zheng
- Department of Radiology, Fujian Medical University Union Hospital, Fujian, China
| | - Yifan Sun
- Department of Radiology, Fujian Medical University Union Hospital, Fujian, China
| | - Yunjing Xue
- Department of Radiology, Fujian Medical University Union Hospital, Fujian, China.
| | - Xinming Huang
- Department of Radiology, Fujian Medical University Union Hospital, Fujian, China.
| |
Collapse
|
17
|
Pay L, Calik AN, Akyuz S, Dayi SU. Successful treatment of patent ductus arteriosus accompanying right-sided aortic arch and aberrant left subclavian artery: a case report. Eur Heart J Case Rep 2022; 6:ytac218. [PMID: 35712224 PMCID: PMC9194800 DOI: 10.1093/ehjcr/ytac218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/11/2021] [Accepted: 05/24/2022] [Indexed: 11/13/2022]
Abstract
Background The coexistence of a right-sided aortic arch (RAA), an aberrant left subclavian artery (ALSA), and a patent ductus arteriosus (PDA) is a rarely seen vascular ring anomaly. There is currently no general guideline consensus on the management and follow-up of this congenital defect, posing a challenge to the clinicians. At this point, the heart team plays a critical role in the management of the disease. Case summary In the present case, a 25-year-old male patient was presented to the outpatient clinic with dyspnoea and fatigue. A transthoracic echocardiography revealed PDA with a left-to-right shunt. To evaluate the anatomy thoroughly, a thoracic computed tomographic angiography was performed and showed PDA accompanying ALSA and RAA. The patient was evaluated by the Heart Team, and a percutaneous closure of PDA was recommended due to signs of left ventricular volume overload. The closure was successfully performed with Amplatzer vascular plug II. At follow-up, the patient was free of symptoms. Discussion Clinicians should be aware of the potential concomitant lesions during the diagnostic work-up. In selected patients, percutaneous closure of PDA may be the first-line therapy in experienced centres.
Collapse
Affiliation(s)
- Levent Pay
- University of Health Sciences, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Surgery Hospital, Department of Cardiology , Istanbul 34668 , Turkey
| | - Ali Nazmi Calik
- University of Health Sciences, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Surgery Hospital, Department of Cardiology , Istanbul 34668 , Turkey
| | - Sukru Akyuz
- University of Health Sciences, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Surgery Hospital, Department of Cardiology , Istanbul 34668 , Turkey
| | - Sennur Unal Dayi
- University of Health Sciences, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Surgery Hospital, Department of Cardiology , Istanbul 34668 , Turkey
| |
Collapse
|
18
|
Zhang X, Chen D, Wu M, Dong H, Wan Z, Jia H, Liang S, Shao J, Zheng J, Xu S, Xiong J, Guo W. Functional Evaluation of Embedded Modular Single-Branched Stent Graft: Application to Type B Aortic Dissection With Aberrant Right Subclavian Artery. Front Cardiovasc Med 2022; 9:869505. [PMID: 35586645 PMCID: PMC9108238 DOI: 10.3389/fcvm.2022.869505] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Endovascular repair of type B aortic dissection (TBAD) with aberrant right subclavian artery (ARSA) is challenging due to anatomical complexity. The embedded modular single-branched stent graft (EMSBSG) could solve this problem. However, the hemodynamic efficacy of this innovative technique has not been fully assessed. This study aimed to propose morphometric and functional indicators to quantify the outcomes of EMSBSG in treating TBAD with ARSA. Material and Methods A patient who had TBAD with ARSA underwent EMSBSG implantation was admitted. Computational fluid dynamics (CFD) and three-dimensional structural analyses were conducted based on CTA datasets before the operation (Pre-1) and at 4 and 25 days after EMSBSG implantation (Post-1 and Post-2). Quantitative and qualitative functional analyses were conducted via pressure-, velocity- and wall shear stress (WSS) -based parameters, such as the luminal pressure difference (LPD), total energy loss, and flow distribution ratio. By precisely registering the aortas at the three time points, parameter variations in the EMSBSG region were also computed to investigate the prognostic improvement after EMSBSG implantation. Results The first balance point of LPD distally shifted to the abdominal aorta in Post-1 by a distance of 20.172 cm, and shifted out of the dissected region in Post-2, indicating positive pressure recovery post EMSBSG. The flow distribution ratios of all aortic arch branches increased after EMSBSG implantation. A positive normal deformation index in the EMSBSG region confirmed true lumen expansion; dominant ARN (area ratio of negative value) of pressure and WSS-based parameters indicated an improved prognosis from Post-1 to Post-2. Conclusions The short-term results of EMSBSG in treating TBAD with ARSA proved to be promising, especially in EMSBSG region. Comprehensive evaluation could provide new insight into the therapy of TBAD with ARSA. Thus, it might guide the further management of complex aortic arch lesions.
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Li T, Zou L, Feng Y, Fan G, Xin Y. Hybrid repair of aberrant right subclavian artery with aortic dissection caused by Kommerell diverticulum. BMC Cardiovasc Disord 2021; 21:562. [PMID: 34809569 PMCID: PMC8607728 DOI: 10.1186/s12872-021-02340-8] [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: 06/21/2021] [Accepted: 10/22/2021] [Indexed: 11/22/2022] Open
Abstract
Background Aberrant right subclavian artery (ARSA) with associated Kommerell diverticulum (KD) is a rare congenital aortic disease. KD patients have a high risk of rupture, dissection, and compression of adjacent structures. Although several treatment options have been proposed (traditional surgery, hybrid operation, and endovascular intervention), a consensus regarding optimal surgical management has not yet been established. Case presentation A case of successful hybrid repair of distal aortic arch dissection aneurysm by dissecting KD and ARSA with debranching of right and left common carotid arteries, left subclavian artery, and stent grafting was presented. Conclusions The hybrid operation is suitable for elderly patients or those with high risks. Along with intervention, the hybrid operation needs to be developed as a minimally invasive method.
Collapse
Affiliation(s)
- Tieyan Li
- Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People's Republic of China.,Shanghai Engineering Research Center of Artificial Heart and Heart Failure Medicine, Shanghai, 200120, People's Republic of China
| | - Lin Zou
- Department of Endocrinology, Shanghai Pudong New Area Gongli Hospital, Shanghai, 200135, People's Republic of China
| | - Yunzhen Feng
- Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People's Republic of China
| | - Guoliang Fan
- Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People's Republic of China
| | - Yuanfeng Xin
- Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People's Republic of China.
| |
Collapse
|
21
|
Cohen-Mussali S, Leon M, Ramírez-Cerda C, Cobos-Gonzalez E, Valdes-Flores J. Hybrid Procedure for Coexistence of Coarctation of the Aorta and Aberrant Right Subclavian Artery: A Case Report and Review of the Literature. Vasc Endovascular Surg 2021; 56:190-195. [PMID: 34569376 DOI: 10.1177/15385744211048309] [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: 11/15/2022]
Abstract
Background: Coarctation of the aorta (CoA) can either present alone as an isolated condition or in association with other aortic arch or cardiac anomalies. One percent of patients with CoA have concomitant an aberrant right subclavian artery (ARSA). Purpose: We report the case of a 35-year-old woman with uncontrolled hypertension who was found to have CoA and ARSA. Results: The patient was treated successfully using a hybrid procedure comprising ARSA ligation and subclavian to carotid transposition, followed by thoracic endovascular aortic repair. Conclusions: Patients with CoA should be carefully studied, considering the possible coexistence of other congenital aortic arch defects, such as ARSA. Hybrid repair is a safe and effective approach for this condition.
Collapse
Affiliation(s)
| | - Monica Leon
- 61188Centro Medico ABC, Ciudad de Mexico, Mexico
| | | | - Ernesto Cobos-Gonzalez
- 61188Centro Medico ABC, Ciudad de Mexico, Mexico.,Hospital Diomed, Ciudad de Mexico, Mexico
| | | |
Collapse
|
22
|
Hashimoto M, Ota T. Seeking optimal management strategy for Kommerell's diverticulum. Eur J Cardiothorac Surg 2021; 60:312-313. [PMID: 34059903 DOI: 10.1093/ejcts/ezab190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Makoto Hashimoto
- Department of Cardiovascular Surgery, Sapporo Cardiovascular Clinic, Hokkaido, Japan
| | - Takeyoshi Ota
- Department of Surgery, Section of Cardiac Surgery, The University of Chicago, Chicago, IL, USA
| |
Collapse
|
23
|
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.
Collapse
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)
| |
Collapse
|
24
|
The Clinical Spectrum of Kommerell's Diverticulum in Adults with a Right-Sided Aortic Arch: A Case Series and Literature Overview. J Cardiovasc Dev Dis 2021; 8:jcdd8030025. [PMID: 33652796 PMCID: PMC7996811 DOI: 10.3390/jcdd8030025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/13/2021] [Accepted: 02/22/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Kommerell's diverticulum is a rare vascular anomaly characterized as an outpouch at the onset of an aberrant subclavian artery. In the variant of a right-sided aortic arch, the trachea and esophagus are enclosed dorsally by the arch. In the configuration of an aberrant left subclavian artery, a Kommerell's diverticulum and persisting ductus arteriosus or ductal ligament enclose the lateral side, forming a vascular ring which may result in (symptomatic) esophageal or tracheal compression. Spontaneous rupture of an aneurysmatic Kommerell's diverticulum has also been reported. Due to the rarity of this condition and underreporting in the literature, the clinical implications of a Kommerell's diverticulum are not well defined. CASE SUMMARY We describe seven consecutive adult patients with a right-sided aortic arch and an aberrant course of the left subclavian artery (arteria lusoria), and a Kommerell's diverticulum, diagnosed in our tertiary hospital. One patient had severe symptoms related to the Kommerell's diverticulum and underwent surgical repair. In total, two of the patients experienced mild non-limiting dyspnea complaints and in four patients the Kommerell's diverticulum was incidentally documented on a computed tomography (CT) scan acquired for a different indication. The size of the Kommerell's diverticulum ranged from 19 × 21 mm to 30 × 29 mm. In the six patients that did not undergo surgery, a strategy of periodic follow-up with structural imaging was pursued. No significant growth of the Kommerell's diverticulum was observed and none of the patients experienced an acute aortic syndrome to date. DISCUSSION Kommerell's diverticulum in the setting of a right-sided aortic arch with an aberrant left subclavian artery is frequently associated with tracheal and esophageal compression and this may result in a varying range of symptoms. Guidelines on management of Kommerell's diverticulum are currently lacking. This case series and literature overview suggests that serial follow-up is warranted in adult patients with a Kommerell's diverticulum with small dimensions and no symptoms, however, that surgical intervention should be considered when patients become symptomatic or when the diameter exceeds 30 mm in the absence of symptoms.
Collapse
|
25
|
Chang Y, Yu CT, Guo HW, Sun XG, Chang Q, Qian XY. Different therapeutic modalities for aortic arch disease combined with Kommerell's diverticulum: single-center experience with nine cases. J Thorac Dis 2020; 12:4711-4716. [PMID: 33145044 PMCID: PMC7578512 DOI: 10.21037/jtd-20-1602] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Aortic arch disease with Kommerell’s diverticulum is an uncommon but troublesome condition, and there are a variety of therapeutic modalities for treating this. We retrospectively analyzed cases who underwent open surgery to summarize different situations and approaches. Methods From November 2015 to January 2019, nine patients underwent operation for the mentioned disorder. Four patients with aortic dissection received total arch replacement. Two patients suffering from type B aortic dissection (TBAD) have accepted graft replacement from ascending aorta (aAO) to descending aorta. Two patients with true aneurysm and congenital malformation underwent graft bypass from aAO to descending aorta. One patient had graft replacement of descending aorta. Results There were nine (eight males and one female) patients with median age of 45 (from 14 to 54) years. The 30-day mortality was 11.1% (1 patient) due to refractory respiratory failure caused by compression of bronchus. One patient had complication of peripheral neuropathy and recovered eventually. Eight patients were followed-up for a median period of 20 [9–46] months. All patients were alive and had no long-term complications except one patient who received re-intervention due to delayed dilation of downstream aorta. Conclusions Treatment for different arch lesions with Kommerell’s diverticulum should follow corresponding indications. Open surgery is the preferred choice and detailed therapeutic strategy depends on the extension of aneurysm, classification and phase of dissection. Stenting might cause airway compression when right-sided arch and vascular ring exist.
Collapse
Affiliation(s)
- Yi Chang
- Department of Vascular Surgery, Fuwai Hospital, Cardiovascular Institute, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Cun-Tao Yu
- Department of Vascular Surgery, Fuwai Hospital, Cardiovascular Institute, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Hong-Wei Guo
- Department of Vascular Surgery, Fuwai Hospital, Cardiovascular Institute, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Xiao-Gang Sun
- Department of Vascular Surgery, Fuwai Hospital, Cardiovascular Institute, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Qian Chang
- Department of Vascular Surgery, Fuwai Hospital, Cardiovascular Institute, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Xiang-Yang Qian
- Department of Vascular Surgery, Fuwai Hospital, Cardiovascular Institute, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| |
Collapse
|
26
|
La Regina D, Prouse G, Mongelli F, Pini R. Two-step treatment of dysphagia lusoria: robotic-assisted resection of aberrant right subclavian artery following aortic debranching. Eur J Cardiothorac Surg 2020; 58:1093-1094. [PMID: 32623473 DOI: 10.1093/ejcts/ezaa182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/26/2020] [Accepted: 04/29/2020] [Indexed: 11/14/2022] Open
Abstract
A 69-year-old female suffering from severe dysphagia due to an aberrant right subclavian artery was treated with a two-step approach. A right carotid-subclavian bypass was followed 2 weeks later by a robotic-assisted thoracoscopic resection of the aberrant right subclavian artery. The postoperative course was uneventful, and the patient immediately recovered from her dysphagia. In our case, the robotic-assisted technology offered major advantages and, based on our experience, may be useful in the treatment of this rare disease.
Collapse
Affiliation(s)
- Davide La Regina
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Giorgio Prouse
- Department of Surgery, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Ramon Pini
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| |
Collapse
|
27
|
Tinelli G, Ferrer C, Giudice R, Ferraresi M, Pogany G, Cao P, Tshomba Y, Montenegro C, De Nigris F, Minelli F, Sica S, Coscarella C. Long-term results of hybrid repair techniques for Kommerell's diverticulum. J Vasc Surg 2020; 72:1213-1221. [DOI: 10.1016/j.jvs.2019.11.052] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/26/2019] [Indexed: 12/17/2022]
|
28
|
Dueppers P, Floros N, Schelzig H, Wagenhäuser M, Duran M. Contemporary Surgical Management of Aberrant Right Subclavian Arteries (Arteria Lusoria). Ann Vasc Surg 2020; 72:356-364. [PMID: 32949736 DOI: 10.1016/j.avsg.2020.08.151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/26/2020] [Accepted: 08/26/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND An aberrant right subclavian artery (ARSA) is in most cases an asymptomatic aortic arch anomaly. However, dysphagia, aneurysm formation (ARSAA), associated Kommerell diverticulum, or cerebellar/arm malperfusion may require invasive therapy. Large-scale clinical trials do not exist in current literature. We report our patient's outcome of a single-center experience and delineate indications for treatment and surgical techniques. METHODS A single-center retrospective study was conducted between January 1, 2012 through March 1, 2018. Symptomatic or asymptomatic patients with ARSAA who received invasive treatment at the Department for Vascular and Endovascular Surgery, University Hospital Dusseldorf, Germany were included. RESULTS Eight patients (4 men, 63 ± 14 (39-78) years) were treated with single-stage (n = 4) or multistage (n = 4) procedures. Treatment for ARSAA (n = 4) included ARSA revascularization (subclavian-carotid transposition (SCT) = 3; carotid-subclavian bypass (CSB) = 1), aortic arch debranching (left SCT = 2, bilateral aorto-carotid bypass + left CSB = 1, right-to-left CSB + left-carotid-to-bypass transposition = 1), and thoracic endovascular aortic repair (TEVAR; n = 4). Other strategies included SCT for dysphagia (n = 2) or subclavian steal syndrome (n = 1) and balloon angioplasty for arm claudication (n = 1). Complications involved vascular access (n = 2) and each one partial common carotid artery overstenting without stroke during TEVAR and Horner syndrome after SCT. Mean follow-up was 23 ± 26 (9-67) months. After 7 months, 1 patient required vertebral artery coiling due to type II endoleak with ARSAA progression. Overall mortality was 0%. Technical and clinical success rates were 100%. CONCLUSIONS Surgical concepts for ARSA aim on preventing aneurysm rupture and alleviate dysphagia or ischemic symptoms. To generate satisfying patient outcomes, individualized therapy planning in specialized centers is vital.
Collapse
Affiliation(s)
- Philip Dueppers
- Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland; Department of Vascular and Endovascular Surgery, University Hospital of Dusseldorf, Duesseldorf, Germany.
| | - Nikolaos Floros
- Department of Vascular and Endovascular Surgery, University Hospital of Dusseldorf, Duesseldorf, Germany
| | - Hubert Schelzig
- Department of Vascular and Endovascular Surgery, University Hospital of Dusseldorf, Duesseldorf, Germany
| | - Markus Wagenhäuser
- Department of Vascular and Endovascular Surgery, University Hospital of Dusseldorf, Duesseldorf, Germany
| | - Mansur Duran
- Department of Surgery: Vascular and Endovascular Surgery, Marienhospital Gelsenkirchen, Gelsenkirchen, Germany
| |
Collapse
|
29
|
|
30
|
Nishi S, Suematsu Y. Single-stage total endovascular therapy for an aberrant right subclavian aneurysm. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:450-453. [PMID: 32875179 PMCID: PMC7451618 DOI: 10.1016/j.jvscit.2020.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 07/02/2020] [Indexed: 11/16/2022]
Abstract
A 34-year-old woman who demonstrated an aberrant right subclavian artery aneurysm was referred to our hospital. Single-stage total endovascular therapy with preservation of the right vertebral artery using a surgeon-modified fenestrated stent graft was performed. Contrast-enhanced computed tomography on postoperative day 4 revealed the patency of the right vertebral artery with no evidence of endoleaks. The patient was discharged on postoperative day 6. Three years later, the patient had no adverse events. When an aberrant right subclavian artery aneurysm is anatomically suitable, single-stage total endovascular therapy for such an aneurysm is considered to be a feasible and appropriate minimally invasive treatment.
Collapse
Affiliation(s)
- Satoshi Nishi
- Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, Ibaraki, Japan
| | - Yoshihiro Suematsu
- Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, Ibaraki, Japan
| |
Collapse
|
31
|
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.
Collapse
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.
| |
Collapse
|
32
|
Tigkiropoulos K, Kousidis P, Lazaridis I, Saratzis N. Hybrid Repair of Distal Aortic Arch Dissection Aneurysm With Dissected Kommerell Diverticulum. Vasc Endovascular Surg 2020; 54:375-377. [PMID: 32270759 DOI: 10.1177/1538574420911261] [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: 11/16/2022]
Abstract
Aberrant right subclavian artery (ARSA) with associated Kommerell diverticulum (KD) is a rare congenital aortic arch anomaly. Patients with KD have a high risk of rupture, dissection, compression of adjacent structures, as well as distal embolization symptoms. Several treatment options have been proposed (surgical, hybrid, endovascular), however, a consensus regarding optimal surgical management has not been established yet. We present a successful single-stage hybrid repair of distal aortic arch dissection aneurysm with dissecting KD and ARSA with debranching of innominate and left common carotid artery, bilateral carotid-subclavian bypass, and stent grafting.
Collapse
Affiliation(s)
- Konstantinos Tigkiropoulos
- Vascular Unit, 1st University Surgical Department, Aristotle University, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Panagiotis Kousidis
- Vascular Unit, 1st University Surgical Department, Aristotle University, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Ioannis Lazaridis
- Vascular Unit, 1st University Surgical Department, Aristotle University, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Nikolaos Saratzis
- Vascular Unit, 1st University Surgical Department, Aristotle University, Papageorgiou General Hospital, Thessaloniki, Greece
| |
Collapse
|
33
|
Plotkin A, Ng B, Han SM, Weaver FA, Ham SW, Bowdish ME, Wilcox AG, Magee GA. Association of aberrant subclavian arteries with aortic pathology and proposed classification system. J Vasc Surg 2020; 72:1534-1543. [PMID: 32238310 DOI: 10.1016/j.jvs.2020.01.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/10/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Aberrant subclavian artery (aSCA) is a rare anatomic variant whose association with other aortic branch variations and aortic pathology has yet to be established. Knowledge of such an association could be relevant to recommendations for screening and awareness as associated variations are important for operative planning. We describe the incidence of aSCA variations, its association with aortic pathology, and a proposed classification system. METHODS The thoracic cross-sectional imaging database at Keck Hospital of the University of Southern California from 2006 to 2018 was queried for presence of aSCA. Studies were evaluated for aSCA laterality, variant anatomy, and aortic and branch vessel disease. Medical records were reviewed for associated symptoms and diagnoses. The primary outcome was association of aSCA with aortic pathology (aneurysm or dissection). Secondary outcomes were comparison of right and left aSCA, comparison between the sexes, and creation of a proposed classification system. RESULTS Of 98,580 axial imaging studies, 810 studies (0.82%) were identified with aSCA in 312 unique patients. Right aSCA made up the majority of cases (90.1%). All aSCAs had a retroesophageal course. Kommerell's diverticulum (KD) was present in 184 (59%) with an average diameter of 1.67 cm (range, 1.2-3.3 cm). KD was more frequent (84% vs 56%; P = .0003) and larger (2.05 cm vs 1.61 cm; P < .0001) in left aSCA patients. When present, KD was more often symptomatic in left aSCA compared with right aSCA (77.4% vs 49.1%; P = .005). Dysphagia, chest pain, reflux, and asthma were all more common in left aSCA patients. KD was also more common in men (73.3% vs 50%; P < .0001) and larger in men (1.81 cm vs 1.54 cm; P < .0001) but with no difference in symptoms between sexes. Our proposed classification system based on aortic arch branching is as follows: type 1, left arch with right aSCA (59.9%); type 2, left arch with common carotid trunk and right aSCA (30.1%); type 3, right arch with left aSCA (9.6%); and type 4, right arch with common carotid trunk and left aSCA (0.3%). Subtypes describe the right vertebral artery (RVA) and left vertebral artery (LVA) origin: subclavian (s, RVA 90.1%, LVA 96.8%), carotid (c, RVA 9.6%, LVA 0.3%), or arch (a, RVA 0.3%, LVA 2.9%). Overall, 9.9% (31/312) had associated aortic pathology, although the study was underpowered to detect a difference between right aSCA and left aSCA (9.3% vs 16.1%; P = .213). Type 3 and type 4 arches more often have associated aortic pathology, KD, and symptoms. CONCLUSIONS aSCAs are frequently symptomatic and commonly associated with aortic dissection and aneurysm. Our proposed classification scheme depicts all four aSCA arch variants and accounts for vertebral artery origin variation. These variants are common, and vertebral anatomy can differ greatly. Knowledge of these anatomic variations is critical to planning for endovascular and open repair of aortic arch pathology.
Collapse
Affiliation(s)
- Anastasia Plotkin
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Brian Ng
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Sukgu M Han
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Fred A Weaver
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Sung W Ham
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Michael E Bowdish
- Division of Cardiothoracic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Alison G Wilcox
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Gregory A Magee
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif.
| |
Collapse
|
34
|
Akbulut M, Ak A, Ozturker K, Sismanoglu M, Tunçer MA. Hybrid Treatment of Complex Aortic Arch Anomaly with Saccular Aneurysm. Braz J Cardiovasc Surg 2019; 34:769-771. [PMID: 31793254 PMCID: PMC6894031 DOI: 10.21470/1678-9741-2018-0229] [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] [Indexed: 11/04/2022] Open
Abstract
Aortic arch anomalies are not clinically important unless they cause compression symptoms due to aneurysmatic dilatation. Aortic anomalies need to be treated when they cause complex thoracic aortic diseases, and the treatment approach has evolved over time from open surgical methods, which have high mortality and morbidity rates, to hybrid methods. A case of a 68-year-old male patient with complex aortic arch anomaly treated with hybrid arch repair is reported in this study. Aortic branches were common carotid trunk and aberrant right subclavian artery with a saccular aneurysm.
Collapse
Affiliation(s)
- Mustafa Akbulut
- Kosuyolu Kartal Heart Training and Research Hospital Department of Cardiovascular Surgery Istanbul Turkey Department of Cardiovascular Surgery, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Adnan Ak
- Kosuyolu Kartal Heart Training and Research Hospital Department of Cardiovascular Surgery Istanbul Turkey Department of Cardiovascular Surgery, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Kenan Ozturker
- Kosuyolu Kartal Heart Training and Research Hospital Department of Cardiovascular Surgery Istanbul Turkey Department of Cardiovascular Surgery, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Mesut Sismanoglu
- Kosuyolu Kartal Heart Training and Research Hospital Department of Cardiovascular Surgery Istanbul Turkey Department of Cardiovascular Surgery, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Altuğ Tunçer
- Kosuyolu Kartal Heart Training and Research Hospital Department of Cardiovascular Surgery Istanbul Turkey Department of Cardiovascular Surgery, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
35
|
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.
Collapse
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
| |
Collapse
|
36
|
Zhang W, Li X, Cai W, Li M, Qiu J, Shu C. Midterm Outcomes of Endovascular Repair for Stanford Type B Aortic Dissection with Aberrant Right Subclavian Artery. J Vasc Interv Radiol 2019; 30:1378-1385. [PMID: 31133449 DOI: 10.1016/j.jvir.2019.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To evaluate the early and midterm outcomes of endovascular repair of Stanford type B aortic dissection (TBAD) with an aberrant right subclavian artery (ARSA). MATERIALS AND METHODS From November 2012 to July 2018, 15 patients (13 male, 2 female) who had TBAD with ARSA underwent total endovascular repair, including thoracic endovascular aortic repair (TEVAR), left subclavian artery (LSA) chimney technique, LSA fenestration technique, and double chimney technique (LSA chimney and ARSA periscope). The mean age was 55 years. Kommerell diverticulum (KD) occurred in 2 patients, which were covered by means of oversized aortic stents. All patients had preoperative imaging examinations for assessing cerebral blood flow and the dominant vertebral arteries. RESULTS All procedures were completed successfully. There was no in-hospital mortality. The mean procedural time was 98 ± 40 minutes (range 50-190). The mean preoperative diameters of the maximum descending aorta, false lumen, and true lumen in the descending aorta versus postoperative were 37 ± 10 mm (range 28-67), 18 ± 9 mm (range 9-41), and 19 ± 6 mm (range 10-35) versus 34 ± 9 mm (range 25-64), 5 ± 8 mm (range 0-28), and 28 ± 5 mm (range 19-37), respectively. Right upper extremity weakness was observed in 2 patients, which recovered gradually during follow-up. Immediate type Ia endoleak was detected in 1 patient. The mean follow-up time was 33 ± 20 months. During follow-up, no ARSA steal syndrome, spinal cord ischemia, or strokes were not observed. CONCLUSIONS Endovascular treatment for TBAD with ARSA was feasible and safe with a satisfactory midterm follow-up outcome.
Collapse
Affiliation(s)
- Weichang Zhang
- Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Number 139, Renmin Road, Changsha, Hunan, People's Republic of China 410011
| | - Xin Li
- Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Number 139, Renmin Road, Changsha, Hunan, People's Republic of China 410011
| | - Wenwu Cai
- Department of General Surgery, Second Xiangya Hospital, Central South University, Number 139, Renmin Road, Changsha, Hunan, People's Republic of China 410011
| | - Ming Li
- Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Number 139, Renmin Road, Changsha, Hunan, People's Republic of China 410011
| | - Jian Qiu
- Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Number 139, Renmin Road, Changsha, Hunan, People's Republic of China 410011
| | - Chang Shu
- Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Number 139, Renmin Road, Changsha, Hunan, People's Republic of China 410011; Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, People's Republic of China.
| |
Collapse
|
37
|
Masciello F, Fargion A, Innocenti AA, Giacomelli E, Voltolini L, Dorigo W, Pratesi C. Open surgical conversion for Type II endoleak following hybrid treatment of a giant aneurysm of aberrant right subclavian artery. J Surg Case Rep 2019; 2019:rjz058. [PMID: 30886695 PMCID: PMC6413370 DOI: 10.1093/jscr/rjz058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 01/31/2019] [Accepted: 02/12/2019] [Indexed: 12/02/2022] Open
Abstract
Type II endoleak following hybrid treatment of aneurysms of aberrant subclavian arteries (AARSA) and requiring reintervention is rare. A retroesophageal AARSA with a 70 mm diameter was treated with left and right carotid to subclavian bypasses and thoracic endografting to exclude its ostium. The distal neck was embolized with a vascular plug. At 22 months postoperatively, an angio-computed tomography (CT) scan performed for worsening of dysphagia showed the presence of a Type II endoleak from bronchial arteries with significant sac enlargement. An open surgical repair with thoracotomy, aneurysmorraphy and ligature of the feeding vessels was successfully performed.
Collapse
Affiliation(s)
- Fabrizio Masciello
- Department of Vascular Surgery, University of Florence, Largo Brambilla 3, Florence, Italy
| | - Aaron Fargion
- Department of Vascular Surgery, University of Florence, Largo Brambilla 3, Florence, Italy
| | | | - Elena Giacomelli
- Department of Vascular Surgery, University of Florence, Largo Brambilla 3, Florence, Italy
| | - Luca Voltolini
- Department of Thoracic Surgery, University of Florence, Largo Brambilla 3, Florence, Italy
| | - Walter Dorigo
- Department of Vascular Surgery, University of Florence, Largo Brambilla 3, Florence, Italy
| | - Carlo Pratesi
- Department of Vascular Surgery, University of Florence, Largo Brambilla 3, Florence, Italy
| |
Collapse
|
38
|
Editor's Choice – Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2019; 57:165-198. [DOI: 10.1016/j.ejvs.2018.09.016] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
39
|
Czerny M, Schmidli J, Adler S, van den Berg JC, Bertoglio L, Carrel T, Chiesa R, Clough RE, Eberle B, Etz C, Grabenwöger M, Haulon S, Jakob H, Kari FA, Mestres CA, Pacini D, Resch T, Rylski B, Schoenhoff F, Shrestha M, von Tengg-Kobligk H, Tsagakis K, Wyss TR, Debus S, de Borst GJ, Di Bartolomeo R, Lindholt J, Ma WG, Suwalski P, Vermassen F, Wahba A, von Ballmoos MCW. Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS). Eur J Cardiothorac Surg 2019; 55:133-162. [PMID: 30312382 DOI: 10.1093/ejcts/ezy313] [Citation(s) in RCA: 277] [Impact Index Per Article: 55.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Jürg Schmidli
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sabine Adler
- Department for Rheumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jos C van den Berg
- Department of Radiology, Centro Vascolare Ticino, Ospedale Regionale di Lugano, Lugano, Switzerland.,Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luca Bertoglio
- Division of Vascular Surgery, "Vita salute" University, Ospedale San Raffaele, Milan, Italy
| | - Thierry Carrel
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roberto Chiesa
- Division of Vascular Surgery, "Vita salute" University, Ospedale San Raffaele, Milan, Italy
| | - Rachel E Clough
- Division of Imaging Sciences and Biomedical Engineering, St Thomas' Hospital, King's College London, London, UK
| | - Balthasar Eberle
- Department for Anesthesiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian Etz
- Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | | | - Stephan Haulon
- Aortic Center, Hôpital Marie Lannelongue, Université Paris Sud, Le Plessis-Robinson, France
| | | | - Fabian A Kari
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Carlos A Mestres
- University Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Timothy Resch
- Department of Vascular Surgery, Vascular Center Skåne University Hospital, Malmö, Sweden
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Malakh Shrestha
- Department of Cardio-thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Hendrik von Tengg-Kobligk
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Thomas R Wyss
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
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.
Collapse
|
41
|
Soo Hoo AJ, Rokkas CK, Rossi PJ. Migration of endovascular plug in hybrid repair of dysphagia lusoria. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2018; 4:140-143. [PMID: 29942904 PMCID: PMC6013000 DOI: 10.1016/j.jvscit.2018.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 02/11/2018] [Indexed: 12/31/2022]
Abstract
Aberrant right subclavian artery is the most common brachiocephalic artery congenital abnormality and may result in dysphagia from external compression by the aberrant artery on the esophagus. Repair of this anatomic variant can be performed by both open and hybrid endovascular techniques. This case illustrates a complication of a hybrid repair resulting in proximal migration of a vascular occlusion plug, presenting as recurrent dysphagia and need for open surgical extraction of the plug.
Collapse
Affiliation(s)
- Andrew J Soo Hoo
- Division of Vascular Surgery, Medical College of Wisconsin, Milwaukee, Wisc
| | - Chris K Rokkas
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisc
| | - Peter J Rossi
- Division of Vascular Surgery, Medical College of Wisconsin, Milwaukee, Wisc
| |
Collapse
|
42
|
Tamayo-Espinosa T, Erdmenger-Orellana J, Becerra-Becerra R, Balderrabano-Saucedo N, Segura-Standford B. Arco aórtico derecho con subclavia izquierda aberrante y divertículo de Kommerell. Una causa de anillo vascular. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2017. [DOI: 10.1016/j.acmx.2017.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
43
|
Harris DG, Huffner ME, Croal-Abrahams L, DiChiacchio L, Farivar BS, Ayers JD, Toursavadkohi S, Rabin J, Crawford RS. Thoracic Endovascular Repair of Blunt Thoracic Aortic Injury in the Setting of an Aberrant Right Subclavian Artery. Ann Vasc Surg 2017; 42:302.e15-302.e20. [PMID: 28390914 DOI: 10.1016/j.avsg.2016.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 12/12/2016] [Accepted: 12/19/2016] [Indexed: 11/18/2022]
Abstract
Blunt thoracic aortic injury (BTAI) in a patient with an aberrant right subclavian artery (ARSA) presents unique challenges for patient management and aortic repair. Specific considerations include the need to treat coincidental ARSA, subclavian revascularization, and ARSA exclusion. Despite the rise of endovascular repair as the primary modality for aortic repair for BTAI, reports of this technique in the setting of ARSA are limited. Here we describe 3 patients with ARSA who underwent TEVAR for BTAI, and discuss critical management and technical issues in these patients.
Collapse
Affiliation(s)
- Donald G Harris
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Michael E Huffner
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Luqman Croal-Abrahams
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Laura DiChiacchio
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Behzad S Farivar
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Joseph D Ayers
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA
| | - Shahab Toursavadkohi
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD; Center for Aortic Disease, University of Maryland Medical Center, Baltimore, MD
| | - Joseph Rabin
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
| | - Robert S Crawford
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD; Center for Aortic Disease, University of Maryland Medical Center, Baltimore, MD.
| |
Collapse
|
44
|
Nicolò F, Costetti A, Carro C, Marianeschi SM. Off-pump Kommerell's diverticulum resection and descending aorta replacement. J Card Surg 2016; 31:544-5. [PMID: 27357614 DOI: 10.1111/jocs.12794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report the case of an unusual variation of a Kommerell's diverticulum in a left aortic arch with an aberrant left subclavian artery, associated with dilatation of the distal aortic arch, surgically treated without the use of extracorporeal circulation.
Collapse
Affiliation(s)
- Francesca Nicolò
- Pediatric Cardiac Surgery Unit, Ca Granda Niguarda Hospital, Milan, Italy
| | | | - Cristina Carro
- Pediatric Cardiac Surgery Unit, Ca Granda Niguarda Hospital, Milan, Italy
| | | |
Collapse
|
45
|
Endovascular Repair of a Descending Thoracic Aortic Aneurysm With an Aberrant Left Subclavian Artery Associated With an Infrarenal Aortic Aneurysm. Ann Thorac Surg 2016; 101:2386-8. [PMID: 27211955 DOI: 10.1016/j.athoracsur.2015.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 07/25/2015] [Accepted: 08/07/2015] [Indexed: 11/24/2022]
Abstract
Aneurysms involving a right-sided descending thoracic aorta with an aberrant origin of the left subclavian artery are rare. We describe the successful surgical repair of this vascular anomaly by the combined use of a left carotid to subclavian artery bypass followed by endovascular stent graft placement to exclude the aortic aneurysm. We also review the literature associated with this particular anatomic presentation.
Collapse
|
46
|
Takahashi S, Katayama K, Takasaki T, Sueda T. One-stage hybrid procedure for aberrant right subclavian artery and thoracic aneurysm. J Vasc Surg Cases 2015; 1:232-235. [PMID: 31724640 PMCID: PMC6849997 DOI: 10.1016/j.jvsc.2015.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 08/17/2015] [Indexed: 11/29/2022] Open
Abstract
A 60-year-old man without any symptoms was referred to our department because computed tomography revealed an aberrant right subclavian artery (ARSA) and a saccular aortic aneurysm arising opposite to the ARSA. We performed the following procedures through a median sternotomy: total arch replacement, insertion of a frozen elephant trunk to exclude the aneurysm and ARSA, placement of a vascular plug under transesophageal ultrasonography to occlude the dilated ARSA, and right axillary artery bypass. Postoperative computed tomography showed complete occlusion of the ARSA and exclusion of the aneurysm. This procedure should be considered an alternative strategy for treatment of patients with an ARSA.
Collapse
Affiliation(s)
- Shinya Takahashi
- Correspondence: Shinya Takahashi, MD, PhD, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| | | | | | | |
Collapse
|
47
|
|
48
|
Evolution in the Management of Aberrant Subclavian Arteries and Related Kommerell Diverticulum. Ann Thorac Surg 2015; 100:47-53. [DOI: 10.1016/j.athoracsur.2015.02.027] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 01/19/2015] [Accepted: 02/12/2015] [Indexed: 11/13/2022]
|
49
|
Schwein A, Georg Y, Ohana M, Delay C, Lejay A, Thaveau F, Chakfe N. Treatment of Aneurysmal Aberrant Right Subclavian Artery with Triple-Barrel Stent Graft. Ann Vasc Surg 2015; 29:595.e1-3. [DOI: 10.1016/j.avsg.2014.10.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/05/2014] [Accepted: 10/07/2014] [Indexed: 10/24/2022]
|
50
|
Wong VW, Katz RD, Higgins JP. Interpretation of upper extremity arteriography: vascular anatomy and pathology [corrected]. Hand Clin 2015; 31:121-34. [PMID: 25455362 DOI: 10.1016/j.hcl.2014.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Understanding the utility and interpretation of upper extremity angiography is critical for the hand surgeon treating vaso-occlusive diseases of the hand. Although invasive and requiring the use of contrast dye, it remains the gold standard for imaging of the vascular system of the upper extremity. Angiography may detect numerous variants of the upper limb arterial system which may contribute to surgical pathology. Extensive vascular collateralization helps to maintain perfusion to the hand and facilitates reconstruction of the upper extremity. It is paramount to remember that angiography is a dynamic study and should represent a "flexible roadmap" for surgical reconstruction.
Collapse
Affiliation(s)
- Victor W Wong
- Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street #200, Baltimore, MD 21218, USA
| | - Ryan D Katz
- Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street #200, Baltimore, MD 21218, USA
| | - James P Higgins
- Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street #200, Baltimore, MD 21218, USA.
| |
Collapse
|