Aortoesophageal fistula associated with a Kommerell diverticulum and right-sided aortic arch

Reyes, Karl G.; Gill, Inderjit S.; Temes, Thomas; Griffin, Noreen

doi:10.1016/j.jtcvs.2007.11.057

Cited by 7 publications

(5 citation statements)

References 3 publications

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“…However, there were some complications, including reoperation regarding leakage (endoleak) and arterial-esophageal fistula. [20][21][22] Size reduction is not always achieved by stent-graft placement, and this procedure may not be suitable for patients with dysphagia due to enlarged KD. 23 In addition, the endovascular technique is not an option when the compression symptoms are caused by vascular ring formation.…”

Section: Discussionmentioning

confidence: 99%

“…24 Significant experience in the management of this pathology has been reported by Cleveland Clinic, where 55 out of 65 patients with KD underwent an open surgery with low mortality and complications; meanwhile, in the endovascular treatment group, which included 10 patients, repeated intervention for leakage (endoleak) took place. [21][22][23][24] The case was discussed with endovascular surgeons in our center. The risk of complications was high due to a large number of major vessels and some organs involved in the process, and anatomy was very difficult for a pure endovascular or hybrid treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Roselli and colleagues published studies, where endovascular treatment of KD was performed using a stent graft. However, there were some complications, including reoperation regarding leakage (endoleak) and arterial‐esophageal fistula 20–22 . Size reduction is not always achieved by stent‐graft placement, and this procedure may not be suitable for patients with dysphagia due to enlarged KD 23 .…”

Section: Discussionmentioning

confidence: 99%

“…Significant experience in the management of this pathology has been reported by Cleveland Clinic, where 55 out of 65 patients with KD underwent an open surgery with low mortality and complications; meanwhile, in the endovascular treatment group, which included 10 patients, repeated intervention for leakage (endoleak) took place 21–24 …”

Section: Discussionmentioning

confidence: 99%

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Surgical treatment of Kommerell's diverticulum

Марченко

Myalyuk

Kadyraliev

et al. 2022

Journal of Cardiac Surgery

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Kommerell's diverticulum (KD) is a rare congenital vascular abnormality due to the formation of an abnormal aortic arch, most commonly associated with dilatation at the proximal part of the aberrant subclavian artery. This article describes an option of surgical treatment in a patient with KD. The proposed new technique of aortic arch surgical reconstruction with a stent-graft placement in the descending aorta reduces CPB time, aortic clamp and circulatory arrest time.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Surgical treatment of Kommerell's diverticulum

Марченко

Myalyuk

Kadyraliev

et al. 2022

Journal of Cardiac Surgery

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“…This was necessary for one of our patients. Six Patients became TEVAR as an emergency procedure, for three patients there was no surgical [10], mit Radiochemotherapie bei Bronchialkarzinom [11], mit einem Komerell'schen Divertikel [12], mit Fremdkörper- [13 -15] oder Laugeningestion [16]. Sekundäre AÖF kommen vor nach Ösophaguschirurgie, nach endoskopisch platzierten Ösophagusstents [17] und vor allem nach vorausgegangener Aortenchirurgie.…”

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Die aortoösophageale Fistel: Stellenwert der Endoskopie in der Diagnostik

et al. 2014

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Zusammenfassung Aorto?sophageale Fisteln (A?F) sind eine seltene Entit?t mit hoher Mortali?t. Prim?re Fisteln sind vor allem verursacht durch thorakale Aortenaneurysmen oder Dissektionen, bei sekund?ren Fisteln geht meist ein endovaskul?res oder offenes Aortenrepair voraus. Da der thorakale endovaskul?re Repair (TEVAR) zunehmend zum Standard wird und hierbei nach der Literatur mit 0,8???7?% eine A?F auftritt, ist in Zukunft mit einer steigenden Anzahl an Fisteln zu rechnen. Eines der Hauptprobleme im Management von A?F ist das Fehlen von?spezifischen Symptomen. Thorakale Schmerzen, Fieber und/oder gastrointestinale Blutungen k?nnen vorhanden sein. Die Treffsicherheit der Diagnostik ist oft niedrig. Anhand von Fallbeispielen sollen Symptomatik, Diagnostik mit besonderem Fokus auf die Endoskopie, individuellen Therapiekonzepte und das Therapieergebnis im Verlauf vorgestellt werden. Im Zeitraum von 2006???2013 wurden in unserer Abteilung ?ber 80?000 Endoskopien durchgef?hrt. Alle Patienten mit einer A?F wurden prospektiv erfasst. Anhand der Akten wurden dann retrospektiv die demografischen Daten, initiale Symptome, diagnostische Methoden und das Outcome analysiert. Im angegebenen Zeitraum behandelten wir 9 Patienten mit einer A?F. Vier Patienten hatten eine prim?re, f?nf eine sekund?re Fistel. Klinische Symptome waren vor allem R?ckenschmerzen (6/9) und H?matemesis (5/9). Die Infektparameter waren bei allen Patienten erh?ht: die Leukozyten waren im Schnitt bei 16,5/nl, das CRP bei 149?mg/l (Range 13???299?mg/l). Die Endoskopie erbrachte in allen F?llen einen pathologischen Befund: im ?sophagus ein auf ansonsten unauff?lliger Schleimhaut imponierendes Areal mit Nekrose oder Wanddefekt oder eine lumenobtruierende Raumforderung. F?r beide Aspekte gibt es kaum Differenzialdiagnosen und in Zusammenschau mit einer thorakalen Aortenpathologie kann die Diagnose A?F in fast allen F?llen gestellt werden. Bei Vorliegen einer akuten Blutung ist die einzige therapeutische Option die Einlage einer Sengstakensonde, um den Transport in den OP zum sofortigen endovaskul?ren Aortenrepair zu erm?glichen. Dies war bei einem unserer Patienten der Fall. Sechs Patienten erhielten ein TEVAR als Notfalltherapie, f?r drei Patienten gab es keine chirurgische Therapieoption mehr. F?r eine definitve Versorgung kommen aufgrund von Begleiterkrankungen nur wenige Patienten infrage, in unserem Kollektiv waren es 3/9. Nach wie vor ist die Mortalit?t der Erkrankung selbst oder der ausgedehnten chirurgischen Eingriffe zur Therapie hoch: nur zwei von neun Patienten haben ?berlebt.

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Kommerell’s diverticulum in the current era: a comprehensive review

Tanaka

Milner

Ota

2015

Gen Thorac Cardiovasc Surg

173

190

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Kommerell's diverticulum is a developmental error with a remnant of fourth dorsal aortic arch, named after Dr. Kommerell, a radiologist, who made the first diagnosis in a living individual. The diverticulum can occur in both the left and right aortic arch, from which an aberrant subclavian artery rises to the contralateral side. Pediatric patients often present with airway symptoms whereas dysphagia and chest discomfort are more common in the adult patients. Computed tomography or magnetic resonance imaging can provide details of the diverticulum, associated arch anomalies, and its relationship with surrounding organs. Recent histological studies indicated the presence of cystic medial necrosis in the diverticulum wall, which would explain the reported high rates of aortic dissection and rupture associated with the diverticulum. Accumulated knowledge on this entity and the recent advancement of imaging techniques, surgical/endovascular strategies, and perioperative management, have led to more aggressive intervention to the diverticulum in the early phase. While still under debate it is generally accepted to consider surgical intervention when the diameter of the diverticulum orifice exceeds over 30 mm, and/or the diameter of the descending aorta adjacent to the diverticulum exceeds over 50 mm. Treatment options include open surgical repair, hybrid endovascular repair, and total endovascular repair. The selection of treatment strategy for Kommerell's diverticulum should be based on the anatomy, comorbidities of the patient, and surgical expertise available. The summaries of open and endovascular repairs of over 210 cases from literature search from 2004 to 2014 are also provided in this review.

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Aortoesophageal fistula associated with a Kommerell diverticulum and right-sided aortic arch

Cited by 7 publications

References 3 publications

Surgical treatment of Kommerell's diverticulum

Surgical treatment of Kommerell's diverticulum

Die aortoösophageale Fistel: Stellenwert der Endoskopie in der Diagnostik

Kommerell’s diverticulum in the current era: a comprehensive review

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