Emergent hybrid surgical approaches for non-dissecting ruptured Kommerell's aneurysm: a case report series

Abstract

Background Kommerell’s aneurysm is a saccular or fusiform dilatation found in 3–8% of Kommerell’s diverticulum cases. A non-dissecting rupture rate of 6% has been reported. If ruptured, emergent surgical correction is usually granted. However, evidence regarding the optimal surgical approach in this acute setting is scarce. In this case report series, we aim to describe our experience managing type-1 non-dissecting ruptured Kommerell's aneurysm with hybrid emergent surgical approaches. Cases presentation From January 2005 to December 2020, three cases of type-1 non-dissecting ruptured Kommerell's aneurysm requiring emergent surgical repair were identified. The mean age was 66.67 ± 7.76 years, and 3/3 were male. The most common symptoms were atypical chest pain, dyspnoea, and headache (2/3). The mean aneurysm’s diameter was 63.67 ± 5.69 mm. Frozen Elephant Trunk was the preferred surgical approach (2/3). The Non-Frozen Elephant Trunk patient underwent a hybrid procedure consisting of a supra-aortic debranching and a zone-2 stent-graft deployment. We found a mean clamp time of 140 ± 60.75 min, cardiac arrest time of 51.33 ± 3.06 min, and a hospital stay of 13.67 ± 5.51 days. The most common complications were surgical-site infection and shock (2/3). Only one patient died (1/3). Conclusion Evidence of management for non-dissecting ruptured Kommerell's aneurysms is scarce. Additional, robust, and more extensive studies are required. The selection of the appropriate surgical approach is challenging, and each patient should be individualized. Frozen Elephant Trunk was feasible for patients requiring emergent surgical repair in our centre. However, other hybrid or open procedures can be performed.

Thoracic Endovascular Aortic Repair Without Subclavian Revascularization of a Ruptured Kommerell Diverticulum

“…KD is a rare developmental abnormality of the aorta associated with an aberrant subclavian artery in 20% to 60% of cases. 1 Surgical correction is recommended for symptomatic patients due to increased growth rates and rupture risks. KD with a right aortic arch, a rare anomaly, is associated with significant risks of distal embolization, dissection, and rupture; risks of rupture and dissection are reportedly up to 53%.…”

“…Factors such as patient health, aortic pathology, and medical resources determine whether open surgical repair or TEVAR should be used to treat a ruptured KD. 1 Decisions regarding procedures for KD should be made based on the patient’s specific case by a skilled team of vascular surgeons and interventional cardiologists. KD’s presence, characterized by a sharply curved aortic arch, predisposes patients to complications such as kinking, graft collapse, or aortic wall injury due to stent fractures.…”