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

Abstract

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.

Two-Stage Hybrid Repair in a Patient with Acute Type A Aortic Dissection Associated with Right Aortic Arch with Aberrant Left Subclavian Artery Originating from a Kommerell Diverticulum

“…4) Tanaka et al reported that the mean Kommerell diverticulum diameter was 4.6 cm ± 1.3 cm when the rupture occurred and 4.6 cm ± 2.0 cm when dissection was performed. 8) In the present case, we judged that surgery was indicated, given the acute type A aortic dissection with ULP and the large Kommerell diverticulum.…”

“…6) Tanaka et al reported that the early operative mortality associated with surgery for Kommerell diverticulum was 11% and that the causes of death included acute pulmonary embolism, multiple organ failure, sepsis, and hemorrhage. 8) Although postoperative outcomes are improving, one-stage, widerange open-graft replacement remains unsafe.…”

Anel vascular: uma causa de desconforto respiratório neonatal frequentemente esquecida

“…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) . Outras complicações no pós-operatório são a persistência dos sintomas respiratórios, frequentemente decorrentes da traqueomalácea, da estenose traqueal ou de lesões do parênquima pulmonar.…”

Rupture of Aneurysm of Valsalva Sinus and Aortopathy in Bicuspid Aortic Valve: A Case Report and Review of Literature

“…the Kommerell's diverticulum in the broad sense), and (3) aortic diverticulum at the level of aorto-ductal junction, ductus diverticulum (this category is not considered as Kommerel's diverticulum). There are reports of the ''Kommerell's diverticulum'' without aberrant subclavian artery, but it seems reasonable to categorize this kind of dilation into the third type [7,8]. The presence of a right subclavian artery aneurysm in an adolescent with a BAV has been recently reported [9].…”