Trends in Endovascular Management of Aberrant Subclavian Artery With Kommerell Diverticulum

Abstract

Most patients with aberrant subclavian artery (ASA) are asymptomatic, and this congenital anomaly is often found incidentally. Kommerell diverticulum (KD), which typically occurs at the proximal origin of ASA, may arise in up to 60% of patients with ASA. 1 Molz G. Burri B. Aberrant subclavian artery (arteria lusoria): sex differences in the prevalence of various forms of the malformation. Evaluation of 1378 observations. Virchows Arch A Pathol Anat Histol. 1978; 380: 303-315 Crossref PubMed Scopus (87) Google Scholar ,2 Simon R.W. Lachat M. Pfammatter T. Amann-Vesti B.R. Giant aneurysm of an aberrant right subclavian artery from the left aortic arch. J Thorac Cardiovasc Surg. 2006; 132: 1478-1479 Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar KD increases the risk of acute aortic dissection or rupture as it grows in size. In this issue of The Annals of Thoracic Surgery, Fukuhara and colleagues 3 Fukuhara S. Ahmed Y. Shiomi S. et al. Aberrant subclavian arteries and associated Kommerell diverticulum: endovascular vs open repair. Ann Thorac Surg. 2022; 114: 2163-2172 Abstract Full Text Full Text PDF Google Scholar examine their 20-year single-institution experience and identified 43 patients with ASA who underwent surgical repair. Among these 43 patients, 26 were treated with an endovascular approach and 17 with open surgery. KD was found in more than 80% of patients. Aortic dissection accounted for 33% of patients. Although all patients were treated with an open approach until 2006, an endovascular approach has been performed frequently since then, and 74% of patients had an endovascular approach between 2014 and 2019. Fukuhara and colleagues 3 Fukuhara S. Ahmed Y. Shiomi S. et al. Aberrant subclavian arteries and associated Kommerell diverticulum: endovascular vs open repair. Ann Thorac Surg. 2022; 114: 2163-2172 Abstract Full Text Full Text PDF Google Scholar showed favorable outcomes with an endovascular approach compared with an open approach, including a shorter length of hospital stay, a lower incidence of pneumonia, and a shorter duration of mechanical ventilation, whereas other complications seemed equivalent, such as in-hospital mortality, stroke, paralysis, and peripheral vascular complications. Although the mean follow-up duration was 7.3 years in open approach group, the endovascular approach group was followed up for a mean of 4 years. Despite the short follow-up, 21% of patients required reintervention. Aberrant Subclavian Arteries and Associated Kommerell Diverticulum: Endovascular vs Open RepairThe Annals of Thoracic SurgeryVol. 114Issue 6PreviewVarious surgical options have been described for the treatment of aberrant subclavian arteries and an associated Kommerell diverticulum. Full-Text PDF