A Systematic Review of Total Thoracic Endovascular Aortic Repair in Treatment of Kommerell Diverticulum Combined with Right-Sided Aortic Arch

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.

Case report: A rare cause of chest pain: Kommerell's diverticulum

“…According to a systemic review endovascular repair was used to treat both symptomatic and asymptomatic cases with safe and favorable results. Thrombosis and shrinkage of the aneurysm were noted in 71% of patients on follow-up CT scans [13] .…”

Mechanical Properties of Three-Dimensional Printed Provisional Resin Materials for Crown and Fixed Dental Prosthesis: A Systematic Review

“…According to Page et al in 2021 [ 29 ], PRISMA 2020 would not assess the quality of systematic reviews; however, familiarity and guidance by its checklist and instructions are crucial to conducting a systematic review that completely captures all recommended information. The reporting of PRISMA in the submitted systematic review follows suit of recently published systematic reviews that also reported guidance by the PRISMA 2020 guidelines without conducting a meta-analysis [ 47 , 48 , 49 ].…”