Outcomes of open and endovascular repair of Kommerell diverticulum

Eur J Cardiothorac Surg. 2021 Jul 30;60(2):305-311. doi: 10.1093/ejcts/ezab072.

Abstract

Objectives: Kommerell diverticulum (KD) is a rare congenital vascular anomaly often associated with an aberrant subclavian artery (ASCA). Definitive indications for intervention remain unclear. We present open and endovascular (EV) operative outcomes in a large contemporary series and propose a management algorithm.

Methods: Between 2004 and 2020, 224 patients presented with ASCA and associated KD to our institution. Of the 43 (19.2%) patients who underwent operative repair, 31 (72.1%) had open surgical (OS) repair via thoracotomy and 12 (27.9%) had EV repair. Univariable and bivariable statistical analyses were conducted stratified by approach. The median follow-up time was 5.4 years (IQR, 2.9-9.7).

Results: Patients in EV group were older (68 years vs 47 years, P < 0.001) and had larger aneurysms (base diameter 3.2 cm vs 21.5 cm, P = 0.007). All patients with dysphagia lusoria were treated with open surgery (n = 20). Asymptomatic patients with incidentally detected KD (50% vs 16.1%), those with chest or back pain (50% vs 19.4%) and patients who presented with an aortic emergency (25% vs 6.5%) were more likely to be treated endovascularly (P = 0.001). Carotid-to-subclavian bypass was used in 38 (88.4%) patients. There were no operative mortalities. In-hospital mortality was similar between groups (3.2% vs 16.7%, P = 0.121). Mid-term mortality was higher in the EV group [4 (33.8%) vs 0, P < 0.001]. There were 2 (15.4%) postoperative strokes in the EV group. There were no statistically significant differences in other postoperative complications or hospital length of stay between groups.

Conclusions: KD can be managed using open or EV approaches with low morbidity and mortality. Treatment strategy should depend on clinical presentation and patient factors.

Keywords: Aberrant subclavian artery; Aortic arch anomaly; Endovascular; Kommerell diverticulum; Subclavian artery aneurysm.

MeSH terms

  • Aorta, Thoracic / diagnostic imaging
  • Aorta, Thoracic / surgery
  • Blood Vessel Prosthesis Implantation*
  • Diverticulum* / diagnostic imaging
  • Diverticulum* / surgery
  • Endovascular Procedures*
  • Heart Defects, Congenital*
  • Humans
  • Retrospective Studies
  • Subclavian Artery / diagnostic imaging
  • Subclavian Artery / surgery
  • Treatment Outcome