Long-term results of hybrid repair techniques for Kommerell's diverticulum

Tinelli, Giovanni; Ferrer, Ciro; Giudice, Rocco; Ferraresi, Marco; Pogany, Gabriele; Cao, Piergiorgio; Tshomba, Yamume; Montenegro, Carlos Antônio Barbosa; Nigris, Francesca De; Minelli, Fabrizio; Sica, Simona; Coscarella, Carlo

doi:10.1016/j.jvs.2019.11.052

Cited by 22 publications

(19 citation statements)

References 27 publications

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“…The graft was placed in PLZ zone 1-distal to the left and right common carotids-according to the modified Ishimaru classification. 12 Final aortography confirmed exclusion of the diverticulum, patency and good placement of the stent graft and absence of angiographically detected endoleaks, thereby deeming the deployment successful according to international standards. 13 Operative time was 210 minutes.…”

Section: Introductionmentioning

confidence: 80%

Hybrid Single-Stage Repair of Kommerell’s Diverticulum in a Right Aortic Arch in a Patient With 22q11.2 Deletion Syndrome

Chourda

Putotto

Versacci

et al. 2022

Vasc Endovascular Surg

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Hybrid single-stage repair of Kommerell’s diverticulum in a right aortic arch. Aortic arch anomalies, isolated or associated with congenital heart defects, are cardiovascular manifestations frequently associated with 22q11.2 deletion syndrome. Kommerell’s diverticulum in the context of a right aortic arch is an exceedingly rare congenital anomaly, consisting in aneurysmal degeneration of the origin of an aberrant left subclavian artery. Open surgical repair has been the treatment paradigm, but in recent years, hybrid and endovascular procedures have also been proposed. In this report we present the case of a patient affected by 22q11.2 deletion syndrome successfully treated for Kommerell’s diverticulum associated with a right-sided aortic arch through a single-stage hybrid procedure, consisting of bilateral carotid-subclavian bypass, exclusion of the diverticulum by an endovascular thoracic stent graft, and aberrant left subclavian artery plug occlusion. This type of hybrid technique can be an excellent alternative to extensive open surgical repairs or when total endovascular repair is deemed unachievable, also in the context of a complex genetic syndrome.

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Section: Introductionmentioning

confidence: 80%

Hybrid Single-Stage Repair of Kommerell’s Diverticulum in a Right Aortic Arch in a Patient With 22q11.2 Deletion Syndrome

Chourda

Putotto

Versacci

et al. 2022

Vasc Endovascular Surg

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“…Thus, a staged approach with extra-anatomic revascularization and thoracic endografting is usually preferred. 1,4 In this technique, the ARSA was preserved through the endovascular debranching conduit from the LSA, which was revascularized by the unilateral LCCA-LSA bypass. This lowers the risk of complications from bilateral cervicotomy and can be performed in a 1-stage operation.…”

Section: Discussionmentioning

confidence: 99%

“…The diameters of the distal aortic arch and the bilateral SCAs measured 28 mm and 11 mm, respectively, and the proximal landing zone (PLZ) was 2 cm in length if zone 1 landing was planned according to the modified Hishimaru classification. 1 A 3-step technique, namely cervical debranching with a LCCA to LSA bypass, TEVAR, and an LSA to ARSA endovascular debranching, was planned for 1-stage repair. This procedure was performed under general anesthesia with open right common femoral artery and left supraclavicular approach.…”

Section: Techniquementioning

confidence: 99%

“…Aberrant right subclavian artery (ARSA) with Kommerell's diverticulum (KD) is the most common congenital variant in a left-sided aortic arch. 1 KD exclusion with preservation of bilateral subclavian arteries (SCAs) is indicated for symptomatic patients with aneurysmal formation, type B aortic dissection (TBAD) and rupture. 2 Various techniques, including open surgical repair, hybrid repair, and total endovascular repair, 3 have been described without consensus on a standard treatment.…”

Section: Introductionmentioning

confidence: 99%

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Hybrid Repair With Endovascular Debranching of the Aberrant Right Subclavian Artery for Complicated Type B Aortic Dissection in Patients With Kommerell’s Diverticulum

Chien

Chou

2021

J Endovasc Ther

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Purpose: Aberrant right subclavian artery (ARSA) associated with Kommerell’s diverticulum (KD) is a common congenital arch anomaly. It can be complicated by type B aortic dissection (TBAD) or aneurysmal formation at its ostium. Recently, hybrid repair with thoracic endovascular aortic repair (TEVAR) has appeared to be more favorable. Due to the normal anatomic proximity of the ARSA to the left subclavian artery (LSA) orifice in KD, coverage of the bilateral subclavian arteries (SCAs) to obtain an adequate proximal landing zone (PLZ) is usually required, and double cervicotomy for SCA revascularization potentially increases the risk of complications. Technique: This technique was demonstrated on a 50-year-old man presenting with progressive aneurysmal formation of KD with ARSA after chronic TBAD. A 3-step technique, namely left cervical debranching with a left common carotid artery to LSA bypass graft, TEVAR, and an LSA-to-ARSA endovascular debranching with a self-expanding covered stent by a through-and-through wire from the right brachial artery to the bypass graft, was performed in a 1-stage repair to cover the primary tear of TBAD and preserve the bilateral SCAs. The postoperative course was uneventful. Conclusion: This technique can prevent complications from double cervicotomy and achieve an adequate PLZ with preservation of the bilateral SCAs for TEVAR.

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“…The age and the comorbidities, especially the unfavourable prognosis of lymphoma, advised against a surgery approach, neither for a hybrid repair attempt (endovascular and open technique). 1 One month later, the patient died for a haemorrhagic shock, most likely due to aneurysm rupture (autopsy not performed). The aneurysm that developed in few months, involving the origin of the anomalous subclavian artery (lusory artery) could be defined as a saccular Kommerell aneurysm.…”

Section: Descriptionmentioning

confidence: 99%