Graft Replacement of Kommerell Diverticulum and In Situ Aberrant Subclavian Artery Reconstruction

Abstract

Early outcomes following graft replacement of Kommerell's diverticulum and in-situ aberrant subclavian artery reconstruction were acceptable. In terms of long-term outcomes, symptomatic improvement and an excellent patency rate among reconstructed aberrant subclavian arteries suggest that in-situ surgical repair is an effective treatment option.

Pleural Approach to Aberrant Right Subclavian Artery in Aortic Surgery

“…In previous reports, the procedures associated with the treatment of the ARSA are needed to operate in the deep mediastinum adjacent to the trachea and esophagus or additional approaches through a supraclavicular or lateral thoracotomy approach. 2,3) These procedures are very troublesome and time consuming. Although not frequently, serious complications including recurrent nerve paralysis and esophageal dysphagia were reported.…”

“…An aberrant right subclavian artery (ARSA) is a rare anomaly and is usually located behind the esophagus and main bronchus. 1) Several reports describe its treatment in aortic surgery, [2][3][4][5][6] but procedures in the posterior mediastinum are often necessary. 2,3) We introduced an extraanatomical axillary artery bypass following the occlusion of the ARSA just at the right side of the thoracic vertebra via the right pleural approach in median sternotomy.…”

Hybrid management of aneurysmal vascular ring and a Kommerell's diverticulum in an adult: Case report

“…An aneurysmal Kommerell's diverticulum giving rise to the subclavian artery is an indication of intervention even without aerodigestive symptoms [ 3 ]. Three scenarios can be considered for surgical management of a Kommerell's diverticulum, depending on extension onto the aorta [ 5 ]. Extension into the distal arch, requiring total arch replacement and ligation of the diverticulum.…”

Invited Commentary

“…In this issue of The Annals of Thoracic Surgery, Ikeno and colleagues [2] report excellent results of surgical treatment of aberrant subclavian artery with Kommerell's diverticulum in 17 patients over an 18-year period. Even within a group with an interest in arch anomalies such interventions were performed about once a year.…”