Aberrant Subclavian Artery Pathologies and Kommerell's Diverticulum: A Review and Analysis of Published Endovascular/Hybrid Treatment Options

Abstract

Aberrant subclavian artery (ASA) is one of the most common congenital vascular anomalies of the aortic arch. The incidences of aberrant right subclavian artery (ARSA) and aberrant left subclavian artery (ALSA) are 0.4% to 2.3% and 0.05%, respectively. Approximately 60% of ARSA patients will have a Kommerell's diverticulum at the origin of the ASA. Symptomatic or aneurysmal ASAs need to be treated. Historically, open operation was the favored method to reconstruct ASA anatomy; however, novel endovascular techniques are now available. Following a brief discussion of embryonic development, symptoms, and treatment history of the ASA and Kommerell's diverticulum, the results of a literature review to collect the worldwide experience of endovascular/hybrid treatment of ASA is presented.

Evolution in the Management of Aberrant Subclavian Arteries and Related Kommerell Diverticulum

“…Twenty-two patients underwent repair of aberrant subclavian arteries and associated Kommerell diverticulum. Indications for intervention included a large Kommerell diverticulum (n [ 18), dysphagia lusoria (n [ 12), rupture (n [ 4), type B aortic dissection (n [ 4), thoracic aortic aneurysm (n [ 2), and coarctation (n [ 1). Patients were treated with either open surgery (n [ 9) or an endovascular approach (n [ 13).…”

“…The aberrant right subclavian artery (ARSA) with a left-sided aortic arch is a relatively common aortic arch anomaly, with a reported incidence of 0.5% to 1.8%, while an aberrant left subclavian artery (ALSA) with a right-sided aortic arch is less prevalent (0.05%) [1,2]. An ASA can arise due to a disturbance in the embryologic complex, with remodeling of the 6 dorsal and ventral arches which form the basis of the branchial arch system.…”

“…An ALSA evolves in a similar pattern when there is involution of the left arch and a persistent right arch. The ASAs originate from the proximal portion of the descending thoracic aorta as the fourth supra-aortic vessel, crossing the midline posterior to the esophagus (80%), between the esophagus and the trachea (15%), or anterior to the trachea (5%) [2].…”

Unusual symptomatic late onset presentation of aberrant right subclavian artery: report of two cases and short literature review

“…The incidence of ARSA varies between studies from 0.4 to 2.3% [6,10]. However, most of the studies come up with an incidence of 0.4 to 0.7% [11].…”

Anel vascular: uma causa de desconforto respiratório neonatal frequentemente esquecida

“…Na presença de divertículo de Kommerell, recomenda-se o reparo do divertículo, secção e sutura do ligamento arterioso ou do canal arterial, e o reimplante da artéria subclávia na artéria carótida esquerda. Nos adultos, vem sendo associado à cirurgia o procedimento endovascular (híbrido) 18 . A complicação operatória mais frequente é o quilotórax, recomendando-se sempre a dissecção próxima ao divertículo (19) .…”