Clinical study on treatment of Kommerell diverticulum with endovascular technique_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Yiren ¹ , XU Zhaoming ² , QI Yixia ¹ , CUI Shijun ¹ , GUO Lianrui ¹ , QI Lixing ¹ , TONG Zhu ¹ , GUO Jianming ¹ ,  GU Yongquan ¹

1. Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, P. R. China;
2. Department of Surgery, People’s Hospital of Horqin Left Wing Houqi, Tongliao, Inner Mongolia 028100, P. R. China;

Corresponding?author：

GU Yongquan, Email: 15901598209@163.com

Keywords：

Kommerell diverticulum; endovascular; stent implantation

DOI：

10.7507/1007-9424.201906044

Video：

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Objective To evaluate efficacy and safety of treatment of Kommerell diverticulum with endovascular technique.Method The retrospective analysis was made on the preoperative clinical data, surgical treatment, and postoperative status of patient with Kommerell diverticulum who underwent the endovascular treatment in the Department of Vascular Surgery, Xuanwu Hospital of Capital Medical University.Results According to the different types and clinical symptoms, the effective endovascular treatment was adopted. The thoracic endovascular aortic repair and coil embolization of Kommerell diverticulum were successfully performed. The postoperative aortic blood flow was unobstructed and the aneurysmal lesion was completely isolated. No endoleakage and intracranial and upper limb ischemia were occurred. The operation time was 55 min and the blood loss was 20 mL. The patient was discharged on day 6 after the operation. No endoleakage, dizziness, and upper limb numbness were found following-up for 12 months.Conclusion For patient with different types of Kommerell diverticulum and different symptoms, who could be treated by appropriate endovascular treatment and it is effective and safety.

Citation： LIU Yiren, XU Zhaoming, QI Yixia, CUI Shijun, GUO Lianrui, QI Lixing, TONG Zhu, GUO Jianming, GU Yongquan. Clinical study on treatment of Kommerell diverticulum with endovascular technique. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(9): 1101-1105. doi: 10.7507/1007-9424.201906044 Copy

1.	Omura A, Yoshida M, Matsuda H, et al. Acute type A aortic dissection in a patient with right aortic arch and an aberrant left subclavian artery arising from Kommerell diverticulum. Interact Cardiovasc Thorac Surg, 2016, 22(4): 493-494.
2.	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.
3.	白衛星, 李天曉, 翟水亭, 等. 主動脈Kommerell憩室數字減影造影分析及文獻復習. 當代醫學, 2010, 16(5): 18-20.
4.	Backer CL, Bharadwaj SN, Eltayeb OM, et al. Double aortic arch with Kommerell diverticulum. Ann Thorac Surg, 2019, 108(1): 161-166.
5.	Silveira JV, Junqueira FP, Silveira CG, et al. Kommerell diverticulum: right aortic arch with anomalous origin of left subclavian artery and duplicity of right vertebral artery in a 16-year-old girl. Am J Case Rep, 2019, 20: 228-232.
6.	Salomonowitz E, Edwards JE, Hunter DW, et al. The three types of aortic diverticula. AJR Am J Roentgenol, 1984, 142(4): 673-679.
7.	Stone WM, Ricotta JJ 2nd, Fowl RJ, et al. Contemporary management of aberrant right subclavian arteries. Ann Vasc Surg, 2011, 25(4): 508-514.
8.	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.
9.	Gomes MM, Bernatz PE, Forth RJ. Arteriosclerotic aneurysm of an aberrant right subclavian artery. Dis Chest, 1968, 54(6): 549-552.
10.	Molz G, Burri B. Aberrant subclavian artery (arteria lusoria): sex differences in the prevalence of various forms of the malformation. Evaluation of 1 378 observations. Virchows Arch A Pathol Anat Histol, 1978, 380(4): 303-315.
11.	Kim KM, Cambria RP, Isselbacher EM, et al. Contemporary surgical approaches and outcomes in adults with Kommerell diverticulum. Ann Thorac Surg, 2014, 98(4): 1347-54.
12.	Backer CL, Mongé MC, Popescu AR, et al. Vascular rings. Semin Pediatr Surg, 2016, 25(3): 165-175.
13.	張少云, 謝明星, 賀林. 超聲診斷 Kommerell 憩室1例. 臨床超聲醫學雜志, 2019, 31(3): 241.
14.	Idrees J, Keshavamurthy S, Subramanian S, et al. Hybrid repair of Kommerell diverticulum. J Thorac Cardiovasc Surg, 2014, 147(3): 973-976.
15.	Backer CL, Hillman N, Mavroudis C, et al. Resection of Kommerell’s diverticulum and left subclavian artery transfer for recurrent symptoms after vascular ring division. Eur J Cardiothorac Surg, 2002, 22(1): 64-69.
16.	Gross RE. Surgical treatment for dysphagia lusoria. Ann Surg, 1946, 124: 532-534.
17.	Esposito RA, Khalil I, Galloway AC, et al. Surgical treatment for aneurysm of aberrant subclavian artery based on acase report and a review of the literature. Thorac Cardiovasc Surg, 1988, 95(5): 888-891.
18.	Barr JG, Sepehripour AH, Jarral OA, et al. A review of the surgical management of right-sided aortic arch aneurysms. Interact Cardiovasc Thorac Surg, 2016, 23(1): 156-162.
19.	劉朝兵, 張松林, 胡旭, 等. 主動脈右弓右降合并 Kommerell’s 憩室主動脈夾層 1 例報告. 血管與腔內血管外科雜志, 2017, 3(5): 1018-1019.
20.	Bidar E, Arrigoni SC, Accord RE. Resection of Kommerell diverticulum and reimplantation of aberrant left subclavian artery in right aortic arch vascular ring. Semin Thorac Cardiovasc Surg, 2018 Dec 7. pii: S1043-0679(18)30366-6. doi: 10.1053/j.semtcvs.2018.11.015.
21.	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.
22.	Rizza A, De Caterina AR, Murzi M, et al. Double carotid-subclavian bypass followed by endovascular exclusion of a Kommerell diverticulum and bilateral subclavian artery occlusion in a right-sided aortic arch. JACC Cardiovasc Interv, 2019, 12(9): e81-e82.
23.	承文龍, 原野, 盧輝俊. 雜交或腔內修復術治療 B 型主動脈夾層合并迷走鎖骨下動脈伴 Kommerell 憩室的療效分析. 中國普通外科雜志, 2017, 26(12): 1541-1546.
24.	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.
25.	劉子豪. Stanford B 型主動脈夾層腔內修復術中左鎖骨下動脈處理的研究進展. 中國普通外科雜志, 2017, 26(6): 781-788.
26.	黃斌, 吳洲鵬, 趙紀春, 等. 腹主動脈瘤腔內修復術后 Ⅱ 型內漏發生的危險因素分析及其處理. 中國普外基礎與臨床雜志, 2014, 21(6): 663-668.
27.	Tempaku A, Kuroiwa T, Nishio A. Aberrant left subclavian artery occlusion in right-sided aortic artery associated with left cerebral infarction: A case report. Interv Neuroradiol, 2018, 24(3): 322-326.
28.	Gafoor S, Stelter W, Bertog S, et al. Fully percutaneous treatment of an aberrant right subclavian artery and thoracic aortic aneurysm. Vasc Med, 2013, 18(3): 139-144.
29.	Sun X, Zhang H, Zhu K, et al. Patient-specific three-dimensional printing for Kommerell’s diverticulum. Int J Cardiol, 2018, 255: 184-187.
30.	Kozlov BN, Panfilov DS, Saushkin VV, et al. Mid-term results of hybrid treatment of aortic dissection combined with Kommerell’s diverticulum. Khirurgiia (Mosk), 2017, (11): 72-76.

1. Omura A, Yoshida M, Matsuda H, et al. Acute type A aortic dissection in a patient with right aortic arch and an aberrant left subclavian artery arising from Kommerell diverticulum. Interact Cardiovasc Thorac Surg, 2016, 22(4): 493-494.
2. 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.
3. 白衛星, 李天曉, 翟水亭, 等. 主動脈Kommerell憩室數字減影造影分析及文獻復習. 當代醫學, 2010, 16(5): 18-20.
4. Backer CL, Bharadwaj SN, Eltayeb OM, et al. Double aortic arch with Kommerell diverticulum. Ann Thorac Surg, 2019, 108(1): 161-166.
5. Silveira JV, Junqueira FP, Silveira CG, et al. Kommerell diverticulum: right aortic arch with anomalous origin of left subclavian artery and duplicity of right vertebral artery in a 16-year-old girl. Am J Case Rep, 2019, 20: 228-232.
6. Salomonowitz E, Edwards JE, Hunter DW, et al. The three types of aortic diverticula. AJR Am J Roentgenol, 1984, 142(4): 673-679.
7. Stone WM, Ricotta JJ 2nd, Fowl RJ, et al. Contemporary management of aberrant right subclavian arteries. Ann Vasc Surg, 2011, 25(4): 508-514.
8. 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.
9. Gomes MM, Bernatz PE, Forth RJ. Arteriosclerotic aneurysm of an aberrant right subclavian artery. Dis Chest, 1968, 54(6): 549-552.
10. Molz G, Burri B. Aberrant subclavian artery (arteria lusoria): sex differences in the prevalence of various forms of the malformation. Evaluation of 1 378 observations. Virchows Arch A Pathol Anat Histol, 1978, 380(4): 303-315.
11. Kim KM, Cambria RP, Isselbacher EM, et al. Contemporary surgical approaches and outcomes in adults with Kommerell diverticulum. Ann Thorac Surg, 2014, 98(4): 1347-54.
12. Backer CL, Mongé MC, Popescu AR, et al. Vascular rings. Semin Pediatr Surg, 2016, 25(3): 165-175.
13. 張少云, 謝明星, 賀林. 超聲診斷 Kommerell 憩室1例. 臨床超聲醫學雜志, 2019, 31(3): 241.
14. Idrees J, Keshavamurthy S, Subramanian S, et al. Hybrid repair of Kommerell diverticulum. J Thorac Cardiovasc Surg, 2014, 147(3): 973-976.
15. Backer CL, Hillman N, Mavroudis C, et al. Resection of Kommerell’s diverticulum and left subclavian artery transfer for recurrent symptoms after vascular ring division. Eur J Cardiothorac Surg, 2002, 22(1): 64-69.
16. Gross RE. Surgical treatment for dysphagia lusoria. Ann Surg, 1946, 124: 532-534.
17. Esposito RA, Khalil I, Galloway AC, et al. Surgical treatment for aneurysm of aberrant subclavian artery based on acase report and a review of the literature. Thorac Cardiovasc Surg, 1988, 95(5): 888-891.
18. Barr JG, Sepehripour AH, Jarral OA, et al. A review of the surgical management of right-sided aortic arch aneurysms. Interact Cardiovasc Thorac Surg, 2016, 23(1): 156-162.
19. 劉朝兵, 張松林, 胡旭, 等. 主動脈右弓右降合并 Kommerell’s 憩室主動脈夾層 1 例報告. 血管與腔內血管外科雜志, 2017, 3(5): 1018-1019.
20. Bidar E, Arrigoni SC, Accord RE. Resection of Kommerell diverticulum and reimplantation of aberrant left subclavian artery in right aortic arch vascular ring. Semin Thorac Cardiovasc Surg, 2018 Dec 7. pii: S1043-0679(18)30366-6. doi: 10.1053/j.semtcvs.2018.11.015.
21. 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.
22. Rizza A, De Caterina AR, Murzi M, et al. Double carotid-subclavian bypass followed by endovascular exclusion of a Kommerell diverticulum and bilateral subclavian artery occlusion in a right-sided aortic arch. JACC Cardiovasc Interv, 2019, 12(9): e81-e82.
23. 承文龍, 原野, 盧輝俊. 雜交或腔內修復術治療 B 型主動脈夾層合并迷走鎖骨下動脈伴 Kommerell 憩室的療效分析. 中國普通外科雜志, 2017, 26(12): 1541-1546.
24. 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.
25. 劉子豪. Stanford B 型主動脈夾層腔內修復術中左鎖骨下動脈處理的研究進展. 中國普通外科雜志, 2017, 26(6): 781-788.
26. 黃斌, 吳洲鵬, 趙紀春, 等. 腹主動脈瘤腔內修復術后 Ⅱ 型內漏發生的危險因素分析及其處理. 中國普外基礎與臨床雜志, 2014, 21(6): 663-668.
27. Tempaku A, Kuroiwa T, Nishio A. Aberrant left subclavian artery occlusion in right-sided aortic artery associated with left cerebral infarction: A case report. Interv Neuroradiol, 2018, 24(3): 322-326.
28. Gafoor S, Stelter W, Bertog S, et al. Fully percutaneous treatment of an aberrant right subclavian artery and thoracic aortic aneurysm. Vasc Med, 2013, 18(3): 139-144.
29. Sun X, Zhang H, Zhu K, et al. Patient-specific three-dimensional printing for Kommerell’s diverticulum. Int J Cardiol, 2018, 255: 184-187.
30. Kozlov BN, Panfilov DS, Saushkin VV, et al. Mid-term results of hybrid treatment of aortic dissection combined with Kommerell’s diverticulum. Khirurgiia (Mosk), 2017, (11): 72-76.

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Clinical study on treatment of Kommerell diverticulum with endovascular technique

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