title: Kommerell's diverticulum in the current era: a comprehensive review.
abstract: Kommerell's diverticulum is a developmental error with a remnant of fourth dorsal aortic arch, named after Dr. Kommerell, a radiologist, who made the first diagnosis in a living individual. The diverticulum can occur in both the left and right aortic arch, from which an aberrant subclavian artery rises to the contralateral side. Pediatric patients often present with airway symptoms whereas dysphagia and chest discomfort are more common in the adult patients. Computed tomography or magnetic resonance imaging can provide details of the diverticulum, associated arch anomalies, and its relationship with surrounding organs. Recent histological studies indicated the presence of cystic medial necrosis in the diverticulum wall, which would explain the reported high rates of aortic dissection and rupture associated with the diverticulum. Accumulated knowledge on this entity and the recent advancement of imaging techniques, surgical/endovascular strategies, and perioperative management, have led to more aggressive intervention to the diverticulum in the early phase. While still under debate it is generally accepted to consider surgical intervention when the diameter of the diverticulum orifice exceeds over 30 mm, and/or the diameter of the descending aorta adjacent to the diverticulum exceeds over 50 mm. Treatment options include open surgical repair, hybrid endovascular repair, and total endovascular repair. The selection of treatment strategy for Kommerell's diverticulum should be based on the anatomy, comorbidities of the patient, and surgical expertise available. The summaries of open and endovascular repairs of over 210 cases from literature search from 2004 to 2014 are also provided in this review.
authors: Department of Surgery, Section of Cardiac and Thoracic Surgery, University of Chicago, 5841 Maryland Avenue, Suite E-500/MC5040, Chicago, IL, 60637, USA.
authors: Akiko
authors: A
authors: Tanaka
authors: Ross
authors: R
authors: Milner
authors: Takeyoshi
authors: T
authors: Ota
mesh_terms: D000328:Adult; D000783:Aneurysm / Q000175:diagnosis / Q000601:surgery*; D000784:Aortic Dissection / Q000175:diagnosis / Q000601:surgery; D001013:Aorta, Thoracic / Q000002:abnormalities*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000601:surgery*; D001019:Aortic Rupture / Q000209:etiology; D018376:Cardiovascular Abnormalities / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D003560:Cysts / Q000175:diagnosis / Q000601:surgery*; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D004240:Diverticulum / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D013348:Subclavian Artery / Q000002:abnormalities* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D054079:Vascular Malformations / Q000175:diagnosis / Q000601:surgery*
references: Interact Cardiovasc Thorac Surg. 2013 Mar;16(3):408-10
references: 23243037
references: Br Heart J. 1966 Nov;28(6):722-39
references: 5332779
references: Ann Thorac Surg. 2007 Nov;84(5):1736-8
references: 17954099
references: Arq Bras Cardiol. 2009 Dec;93(6):e88-90, e101-3
references: 20379620
references: Proc R Soc Med. 1949 Nov;42(11):918-22
references: 15394805
references: Circulation. 2000 Feb 1;101(4):459-60
references: 10653840
references: J Thorac Cardiovasc Surg. 1988 May;95(5):888-91
references: 3283462
references: J Am Coll Cardiol. 2010 Feb 16;55(7):697
references: 20170797
references: Anat Rec. 1954 Jul;119(3):349-56
references: 13197795
references: Ann Thorac Surg. 2013 Feb;95(2):699-701
references: 23336883
references: J Cardiothorac Surg. 2010 May 10;5:35
references: 20459743
references: J Endovasc Ther. 2005 Oct;12 (5):574-8
references: 16212457
references: Pediatr Cardiol. 1990 Apr;11(2):69-71
references: 2349144
references: Ann Thorac Surg. 2007 Mar;83(3):1152-7
references: 17307479
references: Pediatr Cardiol. 2012 Apr;33(4):607-17
references: 22314366
references: Intern Med. 2006;45(10 ):701-2
references: 16778346
references: Asian Cardiovasc Thorac Ann. 2013 Apr;21(2):243-4
references: 24532636
references: J Cardiothorac Vasc Anesth. 2015 Feb;29(1):146-8
references: 24315758
references: J Card Surg. 2014 Jul;29(4):519-22
references: 24438543
references: J Card Surg. 2010 Jul;25(4):390-3
references: 20529153
references: Cardiovasc Intervent Radiol. 2009 Jul;32(4):758-61
references: 19030928
references: Arch Dis Child. 2006 Jan;91(1):52-5
references: 15871985
references: Am J Cardiol. 1982 Aug;50(2):342-6
references: 7048888
references: AJR Am J Roentgenol. 1997 Feb;168(2):481-4
references: 9016231
references: J Thorac Cardiovasc Surg. 2012 Oct;144(4):978-9
references: 22835226
references: Eur J Cardiothorac Surg. 2010 Apr;37(4):957
references: 19945888
references: Eur J Cardiothorac Surg. 2011 Sep;40(3):771
references: 21349734
references: Eur Heart J Cardiovasc Imaging. 2013 Sep;14(9):864
references: 23515217
references: Am J Surg. 1993 May;165(5):628-31
references: 8488950
references: Pediatr Cardiol. 2010 Aug;31(6):933-4
references: 20556374
references: Ann Thorac Surg. 2013 Apr;95(4):e95-6
references: 23522241
references: J Vasc Surg. 2009 Jun;49(6):1577-9
references: 19223135
references: Ann Thorac Surg. 2001 Aug;72 (2):434-8; discussion 438-9
references: 11515879
references: J Thorac Cardiovasc Surg. 2014 Oct;148(4):1423-7
references: 24365271
references: J Vasc Surg. 1998 Aug;28(2):335-9
references: 9719329
references: N Engl J Med. 1967 May 25;276(21):1178-82
references: 6023236
references: J Thorac Cardiovasc Surg. 2005 Jun;129(6):1339-47
references: 15942575
references: Ann Thorac Surg. 2014 Oct;98(4):1347-54
references: 25134861
references: Magn Reson Imaging Clin N Am. 2002 May;10(2):237-51
references: 12424945
references: J Radiol Case Rep. 2013 Dec 01;7(12 ):1-9
references: 24421931
references: Br J Surg. 1979 Feb;66(2):113-6
references: 420980
references: AJR Am J Roentgenol. 1984 Apr;142(4):673-9
references: 6422713
references: J Vasc Interv Radiol. 2012 Nov;23 (11):1443
references: 22980626
references: Angiology. 1965 Sep;16(9):509-13
references: 5829979
references: Am Surg. 1993 Sep;59(9):582-6
references: 8368665
references: Ann Thorac Surg. 2001 May;71(5):1710-1
references: 11383841
references: Arch Surg. 1964 Apr;88:666-74
references: 14107020
references: J Thorac Cardiovasc Surg. 2014 Mar;147(3):973-6
references: 23535153
references: Interact Cardiovasc Thorac Surg. 2010 Dec;11(6):800-2
references: 20829386
references: Ann Thorac Surg. 2011 Feb;91(2):627-9
references: 21256339
references: Ann Cardiol Angeiol (Paris). 2010 Jun;59(3):147-54
references: 19962688
references: Ann Vasc Dis. 2009;2(1):54-7
references: 23555359
references: J Thorac Cardiovasc Surg. 2006 Dec;132(6):1473-5
references: 17140984
references: J Thorac Cardiovasc Surg. 2010 May;139(5):e97-8
references: 19660293
references: Vasc Med. 2013 Jun;18(3):139-44
references: 23720037
references: Ann Thorac Surg. 2012 Aug;94(2):639-41
references: 22579900
references: J Card Surg. 2010 May;25(3):333-5
references: 20331481
references: Ann Thorac Surg. 2012 Apr;93(4):1262-5
references: 22385819
references: J Trauma. 2009 Oct;67(4):E115-7
references: 19820605
references: Ann Vasc Surg. 2014 Jul;28(5):1323.e1-5
references: 24534686
references: J Vasc Surg. 2013 Apr;57(4):951-4
references: 23332243
references: J Pediatr Surg. 2010 Oct;45(10 ):2092-3
references: 20920737
references: Eur J Cardiothorac Surg. 2009 Jul;36(1):188
references: 19375938
references: Ann Thorac Surg. 2012 Oct;94(4):1362-4
references: 23006703
references: Asian Cardiovasc Thorac Ann. 2012 Oct;20(5):587-90
references: 23087307
references: Dis Chest. 1968 Dec;54(6):549-52
references: 5722774
references: Eur J Cardiothorac Surg. 2009 Feb;35(2):370-2
references: 19109028
references: Tex Heart Inst J. 2006;33(4):477-81
references: 17215974
references: Cardiol Young. 2011 Apr;21(2):220-1
references: 21446073
references: Interact Cardiovasc Thorac Surg. 2010 Aug;11(2):202-3
references: 20472649
references: Anesthesiology. 1987 Nov;67(5):729-38
references: 3674473
references: Am J Cardiol. 1980 Apr;45(4):811-8
references: 7361673
references: Eur J Cardiothorac Surg. 1997 Jul;12(1):138-40
references: 9262095
references: Am J Roentgenol Radium Ther Nucl Med. 1964 Oct;92:855-64
references: 14215098
references: Ann Vasc Surg. 2014 Feb;28(2):411-20
references: 24200134
references: J Cardiothorac Surg. 2008 Jul 09;3:43
references: 18613969
references: J Thorac Cardiovasc Surg. 1989 May;97(5):725-31
references: 2651808
references: Circ Cardiovasc Imaging. 2009 Mar;2(2):e6-7
references: 19808569
references: J Thorac Cardiovasc Surg. 2014 Jan;147(1):532-4
references: 24138791
references: J Comput Assist Tomogr. 1987 Nov-Dec;11(6):1071-3
references: 3680694
references: Surg Radiol Anat. 1992;14(1):71-9
references: 1589851
references: Tex Heart Inst J. 2002;29(2):109-12
references: 12075866
references: J Endovasc Ther. 2010 Dec;17 (6):762-6
references: 21142488
references: Int J Cardiol. 2013 Mar 10;163(3):e47-8
references: 23021762
references: Intern Med. 2012;51(11):1437-8
references: 22687859
references: J Thorac Cardiovasc Surg. 2007 Mar;133(3):798-9
references: 17320587
references: Ann Vasc Surg. 2011 May;25(4):508-14
references: 21549920
references: Surg Today. 2014 Feb;44(2):247-51
references: 23624597
references: BMJ Case Rep. 2009;2009:bcr2007087072
references: 21687269
references: J Card Surg. 2010 Jan-Feb;25(1):67-9
references: 19912434
references: Med Clin North Am. 1948 Jul;32:925-49
references: 18877614
references: Interact Cardiovasc Thorac Surg. 2008 Aug;7(4):730-1
references: 18505753
references: Asian Cardiovasc Thorac Ann. 2014 Sep;22(7):882-3
references: 24887877
references: J Thorac Cardiovasc Surg. 2006 Mar;131(3):574-8
references: 16515907
references: J Vasc Surg. 2004 Jan;39(1):131-9
references: 14718830
references: Intern Med. 2007;46(12 ):919-20
references: 17575392
references: Thorac Cardiovasc Surg. 2011 Aug;59(5):307-8
references: 21442585
references: Rev Bras Cir Cardiovasc. 2007 Jul-Sep;22(3):352-4
references: 18157423
references: J Gastroenterol Hepatol. 2007 Nov;22(11):1717-21
references: 17914940
references: Ann Vasc Surg. 2014 Feb;28(2):490.e5-8
references: 24183599
references: Virchows Arch A Pathol Anat Histol. 1978 Dec 4;380(4):303-15
references: 153045
references: J Cardiothorac Vasc Anesth. 2015 Feb;29(1):142-5
references: 24332920
references: AJR Am J Roentgenol. 2004 Mar;182(3):777-84
references: 14975985
references: J Thorac Cardiovasc Surg. 2006 Nov;132(5):1228-30
references: 17059951
references: Cardiovasc Surg. 1994 Feb;2(1):110-3
references: 8049914
references: Vasa. 1982;11(3):223-8
references: 7136242
references: Asian Cardiovasc Thorac Ann. 2009 Dec;17 (6):640-2
references: 20026544
references: Semin Roentgenol. 1989 Apr;24(2):121-6
references: 2499050
references: BMC Cardiovasc Disord. 2014 Aug 20;14 :104
references: 25138741
references: Ann Emerg Med. 2013 Mar;61(3):348-50
references: 22981139
references: J Thorac Cardiovasc Surg. 2007 Apr;133(4):888-92
references: 17382621
references: Ann R Coll Surg Engl. 1979 Jan;61(1):63-7
references: 369446
references: J Vasc Surg. 2012 Dec;56(6):1727-30
references: 22819753
references: Surgery. 1964 Jan;55:1-14
references: 14114264
references: J Thorac Cardiovasc Surg. 2008 Oct;136(4):1091-3
references: 18954660
references: Eur Heart J Cardiovasc Imaging. 2013 Aug;14(8):764
references: 23413083
references: Ann Thorac Surg. 2012 Nov;94(5):1612-7
references: 22884596
references: J Vasc Surg. 1985 Jul;2(4):571-7
references: 3892054
references: Thorax. 1983 Jul;38(7):553-5
references: 6612642
references: Ann Thorac Surg. 2008 Mar;85(3):1074-6
references: 18291202
references: Surg Radiol Anat. 1998;20(3):227-32
references: 9706684
references: Interact Cardiovasc Thorac Surg. 2011 Jan;12 (1):70-1
references: 20923828
references: Clin Anat. 2006 May;19(4):354-7
references: 16092123
references: J Card Surg. 2010 Jan-Feb;25(1):62-4
references: 19811575
references: J Vasc Surg. 2013 Apr;57(4):1123-5
references: 23312832
references: J Vasc Surg. 2009 Oct;50(4):903-6
references: 19576720
references: J Card Surg. 2011 Nov;26(6):637-40
references: 22122377
references: Interact Cardiovasc Thorac Surg. 2012 Mar;14 (3):370-1
references: 22155584
references: Eur J Cardiothorac Surg. 2002 Jul;22(1):64-9
references: 12103375
references: Eur J Radiol. 2006 Jul;59(1):82-7
references: 16513313
references: J Vasc Surg. 2000 Dec;32(6):1208-14
references: 11107094
references: Anesth Analg. 2002 Jun;94(6):1462-4, table of contents
references: 12032007
references: J Vasc Surg. 2013 Apr;57(4):915-25
references: 23375432
references: Ann Surg. 1946 Sep;124(3):532-4
references: 17858859
references: Pediatr Cardiol. 2013;34(8):1952-4
references: 22968291
references: Korean J Intern Med. 2010 Sep;25(3):327-30
references: 20830231
references: Mayo Clin Proc. 1986 Mar;61(3):181-5
references: 3945118
references: Asian Cardiovasc Thorac Ann. 2013 Dec;21(6):724-6
references: 24569334
references: J Thorac Cardiovasc Surg. 2010 Jul;140(1):e5-7
references: 20620371