Progress in surgical treatment of Kommerell's diverticulum_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHENG Long ,  SHANG Yuqiang

The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, P.R.China;

Corresponding author：

SHANG Yuqiang, Email: syq027@163.com

Keywords：

Kommerell's diverticulum; aberrant subclavian artery; hybrid operation; total endovascular repair; review

DOI：

10.7507/1007-4848.202007057

Video：

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Kommerell's diverticulum is a rare congenital abnormal aortic development. The diverticulum can occur in both left and right aortic arches, from which an aberrant subclavian artery rises to the contralateral side. Only a small number of patients with Kommerell's diverticulum present symptoms. Dysphagia, dyspnea, chest discomfort and upper extremity blood pressure difference are common in adult patients. The risk of aortic dissection or aortic aneurysm rupture is higher in such patients than that in patients with normal aorta. Early surgical intervention is recommended to improve the prognosis. Treatment options include open surgical repair, hybrid operation and total endovascular repair. The choice of surgical method depends on the specific anatomy of patients, the patients' state and the preference of surgeons. This paper reviewed and summarized the surgical methods and early results of the treatment of Kommerell's diverticulum reported in the literature from 2015 to 2020.

Citation： CHENG Long, SHANG Yuqiang. Progress in surgical treatment of Kommerell's diverticulum. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(10): 1248-1254. doi: 10.7507/1007-4848.202007057 Copy

1.	Kommerell B. Verlagerung des ösophagus durch eine abnorm verlaufende arteria subclavia dextra (arteria lusoria). Fortschr Geb Roentgenstrahlen, 1936, 54: 590-595.
2.	Backer CL, Russell HM, Wurlitzer KC, et al. Primary resection of Kommerell diverticulum and left subclavian artery transfer. Ann Thorac Surg, 2012, 94(5): 1612-1617.
3.	Tsukube T, Ataka K, Sakata M, et al. Surgical treatment of an aneurysm in the right aortic arch with aberrant left subclavian artery. Ann Thorac Surg, 2001, 71(5): 1710-1711.
4.	Stone WM, Ricotta JJ, Fowl RJ, et al. Contemporary management of aberrant right subclavian arteries. Ann Vasc Surg, 2011, 25(4): 508-514.
5.	Edwards JE. Anomalies of the derivatives of the aortic arch system. Med Clin North Am, 1948, 32: 925-949.
6.	Saran N, Dearani J, Said S, et al. Vascular rings in adults: Outcome of surgical management. Ann Thorac Surg, 2019, 108(4): 1217-1227.
7.	Goldbach A, Dass C, Surapaneni K. Aberrant right vertebral artery with a diverticulum of Kommerell: Review of a rare aortic arch anomaly. J Radiol Case Rep, 2018, 12(5): 19-26.
8.	Lescalié F, Peret M, Reigner B, et al. Reconstruction of an abnormal artery observed in an 11 mm embryo: Considerations on the embryologic origin of the subclavian artery. Surg Radiol Anat, 1992, 14(1): 71-79.
9.	Velasquez G, Nath PH, Castaneda-Zuniga WR, et al. Aberrant left subclavian artery in tetralogy of Fallot. Am J Cardiol, 1980, 45(4): 811-818.
10.	Tanaka A, Milner R, Ota T. Kommerell's diverticulum in the current era: A comprehensive review. Gen Thorac Cardiovasc Surg, 2015, 63(5): 245-259.
11.	Cinà CS, Althani H, Pasenau J, et al. Kommerell's diverticulum and right-sided aortic arch: A cohort study and review of the literature. J Vasc Surg, 2004, 39(1): 131-139.
12.	Idrees J, Keshavamurthy S, Subramanian S, et al. Hybrid repair of Kommerell diverticulum. J Thorac Cardiovasc Surg, 2014, 147(3): 973-976.
13.	Bodine JA, D'Souza VJ, Formanek AG. An unusual type of dissecting thoracic aneurysm in association with right aortic arch. Vasa, 1982, 11(3): 223-228.
14.	Kim KM, Cambria RP, Isselbacher EM, et al. Contemporary surgical approaches and outcomes in adults with Kommerell diverticulum. Ann Thorac Surg, 2014, 98(4): 1347-1354.
15.	Backer CL, Mavroudis C, Rigsby CK, et al. Trends in vascular ring surgery. J Thorac Cardiovasc Surg, 2005, 129(6): 1339-1347.
16.	Ota T, Okada K, Takanashi S, et al. Surgical treatment for Kommerell's diverticulum. J Thorac Cardiovasc Surg, 2006, 131(3): 574-578.
17.	Erben Y, Brownstein AJ, Velasquez CA, et al. Natural history and management of Kommerell's diverticulum in a single tertiary referral center. J Vasc Surg, 2020, 71(6): 2004-2011.
18.	Rizzo JA, Chen J, Fang H, et al. Statistical challenges in identifying risk factors for aortic disease. Aorta (Stamford), 2014, 2(2): 45-55.
19.	Vinnakota A, Idrees JJ, Rosinski BF, et al. Outcomes of repair of Kommerell diverticulum. Ann Thorac Surg, 2019, 108(6): 1745-1750.
20.	Austin EH, Wolfe WG. Aneurysm of aberrant subclavian artery with a review of the literature. J Vasc Surg, 1985, 2(4): 571-577.
21.	Vucemilo I, Harlock JA, Qadura M, et al. Hybrid repair of symptomatic aberrant right subclavian artery and Kommerell's diverticulum. Ann Vasc Surg, 2014, 28(2): 411-420.
22.	Dieffenbach BV, Sharma G, Shah SK, et al. Aberrant subclavian artery division and revascularization by a supraclavicular approach for definitive or staged treatment of dysphagia lusoria. J Vasc Surg, 2020, 72(1): 219-225.
23.	Morishita A, Tomioka H, Katahira S, et al. Surgical treatment for Kommerell's diverticulum associated with a right-sided aortic arch and an aberrant left subclavian artery: Endovascular or hybrid. Ann Vasc Dis, 2019, 12(2): 228-232.
24.	Ikeno Y, Koda Y, Yokawa K, et al. Graft replacement of Kommerell diverticulum and in situ aberrant subclavian artery reconstruction. Ann Thorac Surg, 2019, 107(3): 770-779.
25.	Sun X, Zhang H, Zhu K, et al. Patient-specific three-dimensional printing for Kommerell's diverticulum. Int J Cardiol, 2018, 255: 184-187.
26.	Smith R, Attaran S, Field M, et al. Management of a chronic stanford type B dissection in a patient with a right-sided aortic arch. Interact Cardiovasc Thorac Surg, 2011, 13(5): 523-525.
27.	Chang Y, Guo HW, Yu CT, et al. Surgical treatment for Kommerell's diverticulum associated with aortic dissection involving aortic arch. J Card Surg, 2019, 34(11): 1273-1278.
28.	Rosu C, Dorval JF, Abraham CZ, et al. Single-stage hybrid repair of right aortic arch with Kommerell's diverticulum. Ann Thorac Surg, 2017, 103(4): e381-e384.
29.	Wooster M, Back M, Sutzko D, et al. A 10-year experience using a hybrid endovascular approach to treat aberrant subclavian arterial aneurysms. Ann Vasc Surg, 2018, 46: 60-64.
30.	Tinelli G, Ferrer C, Giudice R, et al. Long-term results of hybrid repair techniques for Kommerell's diverticulum. J Vasc Surg, 2020, 72(4): 1213-1221.
31.	国家心血管病专家委员会血管外科专业委员会. 杂交技术治疗累及弓部主动脉病变的中国专家共识. 中国医学前沿杂志(电子版), 2020, 12(2): 18-24.
32.	Hara M, Fujii T, Kawasaki M, et al. Endovascular treatment for Kommerell's diverticulum with a right-sided aortic arch. Ann Vasc Dis, 2017, 10(1): 74-76.
33.	Zhang W, Li X, Cai W, et al. Midterm outcomes of endovascular repair for stanford type B aortic dissection with aberrant right subclavian artery. J Vasc Interv Radiol, 2019, 30(9): 1378-1385.
34.	Gao P, Wang M, Dong D, et al. Endovascular repair of a Kommerell diverticulum anomaly. Ann Thorac Surg, 2015, 99(5): 1801-1803.
35.	Hsu HL, Huang CY, Chen JS. Total endovascular repair for acute type b dissection in the setting of right aortic arch with aberrant left subclavian artery and Kommerell diverticulum. J Thorac Cardiovasc Surg, 2015, 150: 409-411.
36.	Li Z, Wu R, Liu C, et al. Endovascular repair for Kommerell diverticulum with type A aortic dissection. Ann Thorac Surg, 2020, 110(3): e217-e219.
37.	Shingaki M, Kurimoto Y, Morishita K, et al. Anatomical repair for Kommerell diverticulum with deep site in-situ fenestration. Asian Cardiovasc Thorac Ann, 2018, 26(6): 467-469.
38.	Weiss S, Haligür D, Jungi S, et al. Symptomatic or aneurysmal aberrant subclavian arteries: Results of surgical and hybrid repair. Interact Cardiovasc Thorac Surg, 2019, 29(3): 344-351.
39.	Murakami M, Morikage N, Yamashita O, et al. Hybrid endovascular treatment for an asymptomatic Kommerell diverticulum at the right aortic arch. J Vasc Surg, 2016, 64(5): 1485.
40.	Quintana E, Bruce C, Sabate Rotes A. Anatomical aortic reconstruction in Marfan disease: Dismantling of a hybrid repair. Eur J Cardiothorac Surg, 2015, 48: 507-509.
41.	Doi T, Sakata K, Gyoten T, et al. 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. Ann Vasc Dis, 2016, 9(3): 223-227.

1. Kommerell B. Verlagerung des ösophagus durch eine abnorm verlaufende arteria subclavia dextra (arteria lusoria). Fortschr Geb Roentgenstrahlen, 1936, 54: 590-595.
2. Backer CL, Russell HM, Wurlitzer KC, et al. Primary resection of Kommerell diverticulum and left subclavian artery transfer. Ann Thorac Surg, 2012, 94(5): 1612-1617.
3. Tsukube T, Ataka K, Sakata M, et al. Surgical treatment of an aneurysm in the right aortic arch with aberrant left subclavian artery. Ann Thorac Surg, 2001, 71(5): 1710-1711.
4. Stone WM, Ricotta JJ, Fowl RJ, et al. Contemporary management of aberrant right subclavian arteries. Ann Vasc Surg, 2011, 25(4): 508-514.
5. Edwards JE. Anomalies of the derivatives of the aortic arch system. Med Clin North Am, 1948, 32: 925-949.
6. Saran N, Dearani J, Said S, et al. Vascular rings in adults: Outcome of surgical management. Ann Thorac Surg, 2019, 108(4): 1217-1227.
7. Goldbach A, Dass C, Surapaneni K. Aberrant right vertebral artery with a diverticulum of Kommerell: Review of a rare aortic arch anomaly. J Radiol Case Rep, 2018, 12(5): 19-26.
8. Lescalié F, Peret M, Reigner B, et al. Reconstruction of an abnormal artery observed in an 11 mm embryo: Considerations on the embryologic origin of the subclavian artery. Surg Radiol Anat, 1992, 14(1): 71-79.
9. Velasquez G, Nath PH, Castaneda-Zuniga WR, et al. Aberrant left subclavian artery in tetralogy of Fallot. Am J Cardiol, 1980, 45(4): 811-818.
10. Tanaka A, Milner R, Ota T. Kommerell's diverticulum in the current era: A comprehensive review. Gen Thorac Cardiovasc Surg, 2015, 63(5): 245-259.
11. Cinà CS, Althani H, Pasenau J, et al. Kommerell's diverticulum and right-sided aortic arch: A cohort study and review of the literature. J Vasc Surg, 2004, 39(1): 131-139.
12. Idrees J, Keshavamurthy S, Subramanian S, et al. Hybrid repair of Kommerell diverticulum. J Thorac Cardiovasc Surg, 2014, 147(3): 973-976.
13. Bodine JA, D'Souza VJ, Formanek AG. An unusual type of dissecting thoracic aneurysm in association with right aortic arch. Vasa, 1982, 11(3): 223-228.
14. Kim KM, Cambria RP, Isselbacher EM, et al. Contemporary surgical approaches and outcomes in adults with Kommerell diverticulum. Ann Thorac Surg, 2014, 98(4): 1347-1354.
15. Backer CL, Mavroudis C, Rigsby CK, et al. Trends in vascular ring surgery. J Thorac Cardiovasc Surg, 2005, 129(6): 1339-1347.
16. Ota T, Okada K, Takanashi S, et al. Surgical treatment for Kommerell's diverticulum. J Thorac Cardiovasc Surg, 2006, 131(3): 574-578.
17. Erben Y, Brownstein AJ, Velasquez CA, et al. Natural history and management of Kommerell's diverticulum in a single tertiary referral center. J Vasc Surg, 2020, 71(6): 2004-2011.
18. Rizzo JA, Chen J, Fang H, et al. Statistical challenges in identifying risk factors for aortic disease. Aorta (Stamford), 2014, 2(2): 45-55.
19. Vinnakota A, Idrees JJ, Rosinski BF, et al. Outcomes of repair of Kommerell diverticulum. Ann Thorac Surg, 2019, 108(6): 1745-1750.
20. Austin EH, Wolfe WG. Aneurysm of aberrant subclavian artery with a review of the literature. J Vasc Surg, 1985, 2(4): 571-577.
21. Vucemilo I, Harlock JA, Qadura M, et al. Hybrid repair of symptomatic aberrant right subclavian artery and Kommerell's diverticulum. Ann Vasc Surg, 2014, 28(2): 411-420.
22. Dieffenbach BV, Sharma G, Shah SK, et al. Aberrant subclavian artery division and revascularization by a supraclavicular approach for definitive or staged treatment of dysphagia lusoria. J Vasc Surg, 2020, 72(1): 219-225.
23. Morishita A, Tomioka H, Katahira S, et al. Surgical treatment for Kommerell's diverticulum associated with a right-sided aortic arch and an aberrant left subclavian artery: Endovascular or hybrid. Ann Vasc Dis, 2019, 12(2): 228-232.
24. Ikeno Y, Koda Y, Yokawa K, et al. Graft replacement of Kommerell diverticulum and in situ aberrant subclavian artery reconstruction. Ann Thorac Surg, 2019, 107(3): 770-779.
25. Sun X, Zhang H, Zhu K, et al. Patient-specific three-dimensional printing for Kommerell's diverticulum. Int J Cardiol, 2018, 255: 184-187.
26. Smith R, Attaran S, Field M, et al. Management of a chronic stanford type B dissection in a patient with a right-sided aortic arch. Interact Cardiovasc Thorac Surg, 2011, 13(5): 523-525.
27. Chang Y, Guo HW, Yu CT, et al. Surgical treatment for Kommerell's diverticulum associated with aortic dissection involving aortic arch. J Card Surg, 2019, 34(11): 1273-1278.
28. Rosu C, Dorval JF, Abraham CZ, et al. Single-stage hybrid repair of right aortic arch with Kommerell's diverticulum. Ann Thorac Surg, 2017, 103(4): e381-e384.
29. Wooster M, Back M, Sutzko D, et al. A 10-year experience using a hybrid endovascular approach to treat aberrant subclavian arterial aneurysms. Ann Vasc Surg, 2018, 46: 60-64.
30. Tinelli G, Ferrer C, Giudice R, et al. Long-term results of hybrid repair techniques for Kommerell's diverticulum. J Vasc Surg, 2020, 72(4): 1213-1221.
31. 国家心血管病专家委员会血管外科专业委员会. 杂交技术治疗累及弓部主动脉病变的中国专家共识. 中国医学前沿杂志(电子版), 2020, 12(2): 18-24.
32. Hara M, Fujii T, Kawasaki M, et al. Endovascular treatment for Kommerell's diverticulum with a right-sided aortic arch. Ann Vasc Dis, 2017, 10(1): 74-76.
33. Zhang W, Li X, Cai W, et al. Midterm outcomes of endovascular repair for stanford type B aortic dissection with aberrant right subclavian artery. J Vasc Interv Radiol, 2019, 30(9): 1378-1385.
34. Gao P, Wang M, Dong D, et al. Endovascular repair of a Kommerell diverticulum anomaly. Ann Thorac Surg, 2015, 99(5): 1801-1803.
35. Hsu HL, Huang CY, Chen JS. Total endovascular repair for acute type b dissection in the setting of right aortic arch with aberrant left subclavian artery and Kommerell diverticulum. J Thorac Cardiovasc Surg, 2015, 150: 409-411.
36. Li Z, Wu R, Liu C, et al. Endovascular repair for Kommerell diverticulum with type A aortic dissection. Ann Thorac Surg, 2020, 110(3): e217-e219.
37. Shingaki M, Kurimoto Y, Morishita K, et al. Anatomical repair for Kommerell diverticulum with deep site in-situ fenestration. Asian Cardiovasc Thorac Ann, 2018, 26(6): 467-469.
38. Weiss S, Haligür D, Jungi S, et al. Symptomatic or aneurysmal aberrant subclavian arteries: Results of surgical and hybrid repair. Interact Cardiovasc Thorac Surg, 2019, 29(3): 344-351.
39. Murakami M, Morikage N, Yamashita O, et al. Hybrid endovascular treatment for an asymptomatic Kommerell diverticulum at the right aortic arch. J Vasc Surg, 2016, 64(5): 1485.
40. Quintana E, Bruce C, Sabate Rotes A. Anatomical aortic reconstruction in Marfan disease: Dismantling of a hybrid repair. Eur J Cardiothorac Surg, 2015, 48: 507-509.
41. Doi T, Sakata K, Gyoten T, et al. 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. Ann Vasc Dis, 2016, 9(3): 223-227.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Progress in surgical treatment of Kommerell's diverticulum

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