Kommerell's Diverticulum and Early Endovascular Treatment

Abstract

In their recent and interesting article, Li and colleagues1Li Z. Wu R. Liu C. et al.Endovascular repair for Kommerell diverticulum with type A aortic dissection.Ann Thorac Surg. 2020; 110: e217-e219Abstract Full Text Full Text PDF Scopus (4) Google Scholar reported their clinical case on the total endovascular treatment of a 39-year-old man with a 1-year history of Kommerell diverticulum (KD) complicated with chronic retrograde type A aortic dissection. Aneurysmal degeneration of aberrant subclavian artery (ARSA) is known as KD and is associated with a high tendency toward rupture and dissection. Currently, there are no guidelines regarding KD management, and a specific strategy for the surgical treatment of ARSA with or without KD has not yet been established. The standard treatment for KD had been conventional open surgery until the advent of the endovascular and hybrid era. We agree regarding the usefulness of hybrid procedures or an endovascular procedure, because the mortality associated with open surgery in these complex cases is close to 16%.2Odero A. Bozzani A. Pirrelli S. Endovascular treatment of acute type B dissection and Kommerell's diverticulum.Ann Thorac Surg. 2007; 84: 1736-1738Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar,3Arici V. Bozzani A. Odero A. Successful endovascular treatment of a bronchial artery aneurysm refractory to transcatheter embolization.Ann Vasc Surg. 2013; 27: 802.e13-802.e15Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar A still controversial aspect remains the correct timing of the treatment of uncomplicated aortic dissection. Recent reports indicated considerable aortic diameter progression in conservatively treated patients that results in high conversion rates from conservative to invasive treatment. Furthermore, 2 randomized multicenter trials showed better aortic remodeling after thoracic endovascular aortic repair in uncomplicated subacute or acute dissections compared with conservative treatment, and in our experience at 5 years of follow-up, computed tomographic scans revealed complete retraction of the KD with remodeling of the aortic arch.4Bozzani A. Arici V. Bonalumi G. Argenteri A. Descending thoracic aorta remodeling after multilayer stent release.Ann Vasc Surg. 2015; 29 (1018.e9-1018.e11)Abstract Full Text Full Text PDF Scopus (11) Google Scholar,5Pirrelli S. Bozzani A. Arici V. Odero A. Complete aortic arch remodeling after stent graft of acute type B dissection and Kommerell's diverticulum.Ann Thorac Surg. 2012; 93: 673Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar We think that total endovascular therapy provides a safe and reliable tool complementing the armament of surgical techniques in the treatment of patients with aortic dissection and ARSA associated with KD, and that it gives the best results in the acute or subacute phase; additional experience is mandatory before this technique can prove to be effective. Endovascular Repair for Kommerell Diverticulum With Type A Aortic DissectionThe Annals of Thoracic SurgeryVol. 110Issue 3PreviewTotal endovascular repair remains challenging for Kommerell diverticulum with chronic type A aortic dissection. We reported the first total endovascular repair for a Kommerell diverticulum with chronic retrograde type A aortic dissection. We conducted total endovascular repair with a unibody, single-branched, stent-graft combined with the chimney technique for reconstruction of both subclavian arteries. Completion angiography showed complete exclusion of the primary entry tear without endoleak and patency of all stent-grafts, and computed tomographic angiography at follow-up showed significant remodeling of the false lumen. Full-Text PDF