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Matta R, Shah A, Bandesha H, Thiagarajasubramanian S, Muluk S. Case Report: Successful Treatment of Aberrant Left Subclavian Artery With a Right-Sided Aortic Arch. Vasc Endovascular Surg 2024; 58:392-395. [PMID: 37943979 DOI: 10.1177/15385744231215584] [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: 11/12/2023]
Abstract
Right sided aortic arches with concomitant aberrant left subclavian arteries are exceedingly rare anatomical variants. We present a case of a 45 year old male that presented with symptoms consistent with dysphagia and known right sided aortic arch with an aberrant left subclavian artery. Though previous reports of repair have indeed been reported, we confirm that a hybrid approach to these anatomic variants remain feasible and with symptom resolution for patients.
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Affiliation(s)
- Rishabh Matta
- Division of Vascular Surgery, Department of Thoracic and Cardiovascular surgery, Allegheny Health Network, Pittsburgh, PA, USA
| | - Anil Shah
- Division of Vascular Surgery, Department of Thoracic and Cardiovascular surgery, Allegheny Health Network, Pittsburgh, PA, USA
| | - Harmanpreet Bandesha
- Division of Vascular Surgery, Department of Thoracic and Cardiovascular surgery, Allegheny Health Network, Pittsburgh, PA, USA
| | - Shruthi Thiagarajasubramanian
- Division of Vascular Surgery, Department of Thoracic and Cardiovascular surgery, Allegheny Health Network, Pittsburgh, PA, USA
| | - Satish Muluk
- Division of Vascular Surgery, Department of Thoracic and Cardiovascular surgery, Allegheny Health Network, Pittsburgh, PA, USA
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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.
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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
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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.
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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.
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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.
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Chourda E, Putotto C, Versacci P, Saltarocchi S, D'Abramo M, Tshomba Y, Tinelli G, Miraldi F. Hybrid Single-Stage Repair of Kommerell's Diverticulum in a Right Aortic Arch in a Patient With 22q11.2 Deletion Syndrome. Vasc Endovascular Surg 2022; 56:595-601. [PMID: 35442127 DOI: 10.1177/15385744221090911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hybrid single-stage repair of Kommerell's diverticulum in a right aortic arch.Aortic arch anomalies, isolated or associated with congenital heart defects, are cardiovascular manifestations frequently associated with 22q11.2 deletion syndrome. Kommerell's diverticulum in the context of a right aortic arch is an exceedingly rare congenital anomaly, consisting in aneurysmal degeneration of the origin of an aberrant left subclavian artery. Open surgical repair has been the treatment paradigm, but in recent years, hybrid and endovascular procedures have also been proposed. In this report we present the case of a patient affected by 22q11.2 deletion syndrome successfully treated for Kommerell's diverticulum associated with a right-sided aortic arch through a single-stage hybrid procedure, consisting of bilateral carotid-subclavian bypass, exclusion of the diverticulum by an endovascular thoracic stent graft, and aberrant left subclavian artery plug occlusion. This type of hybrid technique can be an excellent alternative to extensive open surgical repairs or when total endovascular repair is deemed unachievable, also in the context of a complex genetic syndrome.
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Affiliation(s)
- Emmanouela Chourda
- Department of Clinical, Internal Medicine, Anaesthesiology and Cardiovascular Sciences, 9311Sapienza University of Rome, Rome, Italy
| | - Carolina Putotto
- Department of Pediatrics, Obstetrics and Gynecology, 9311Sapienza University of Rome, Rome, Italy
| | - Paolo Versacci
- Department of Pediatrics, Obstetrics and Gynecology, 9311Sapienza University of Rome, Rome, Italy
| | - Sara Saltarocchi
- Department of Clinical, Internal Medicine, Anaesthesiology and Cardiovascular Sciences, 9311Sapienza University of Rome, Rome, Italy
| | - Mizar D'Abramo
- Department of Clinical, Internal Medicine, Anaesthesiology and Cardiovascular Sciences, 9311Sapienza University of Rome, Rome, Italy
| | - Yamume Tshomba
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 96983Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Tinelli
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 96983Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabio Miraldi
- Department of Clinical, Internal Medicine, Anaesthesiology and Cardiovascular Sciences, 9311Sapienza University of Rome, Rome, Italy
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Xu X, Wang D, Hou N, Zhou H, Li J, Tian L. Thoracic Endovascular Aortic Repair for Aberrant Subclavian Artery and Stanford Type B Aortic Intramural Hematoma. Front Surg 2022; 8:813970. [PMID: 35223970 PMCID: PMC8878622 DOI: 10.3389/fsurg.2021.813970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/28/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives To evaluate the in-hospital and later outcomes of thoracic endovascular aortic repair (TEVAR) for type B intramural hematoma (TBIMH) combined with an aberrant subclavian artery (aSCA). Methods In the period from January 2014 to December 2020, 12 patients diagnosed with TBIMH combined with aSCA and treated by TEVAR were enrolled in this retrospective cohort study, including 11 patients with the aberrant right subclavian artery (ARSA) and 1 with an aberrant left subclavian artery (ALSA). A handmade fenestrated stent-graft or chimney stent or hybrid repair was performed when the proximal landing zone was not enough. Results The mean age of all the patients was 59.2 ± 7.6 years, and 66.7% of patients were men. There were 4 patients with Kommerell's diverticulum (KD). The procedures in all 12 patients were technically successful. There was one case each of postoperative delirium, renal impairment, and type IV endoleak after TEVAR. During follow-up, 1 patient died of acute pancreatitis 7 months after TEVAR. The overall survival at 1, 3, and 5 years for the patients was 90.9, 90.9, and 90.9%, respectively. KD was excluded in 2 patients, and the handmade fenestrated stent-graft was applied in the other 2 patients to preserve the blood flow of the aSCA. No neurological complications developed and no progression of KD was observed during the follow-up. Conclusion Thoracic endovascular aortic repair for patients with aSCA and TBIMH is promising. When KD was combined, we could exclude KD or preserve the blood flow of aSCA with regular follow-up for the diverticulum according to the size of the KD.
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Affiliation(s)
- Xia Xu
- Department of Cardiothoracic and Vascular Surgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Daoquan Wang
- Department of Cardiothoracic and Vascular Surgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Ningxin Hou
- Department of Cardiothoracic and Vascular Surgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Hongmin Zhou
- Department of Cardiothoracic and Vascular Surgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Li
- Department of Cardiothoracic and Vascular Surgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Liang Tian
- Department of Neurosurgery, Taikang Tongji (Wuhan) Hospital, Wuhan, China
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