Evolution in the Management of Aberrant Subclavian Arteries and Related Kommerell Diverticulum.
BACKGROUND
Various options have been described to treat aberrant subclavian arteries and associated Kommerell diverticulum. We describe our experience with the management of this entity over a 15-year period.


METHODS
Twenty-two patients underwent repair of aberrant subclavian arteries and associated Kommerell diverticulum. Indications for intervention included a large Kommerell diverticulum (n = 18), dysphagia lusoria (n = 12), rupture (n = 4), type B aortic dissection (n = 4), thoracic aortic aneurysm (n = 2), and coarctation (n = 1). Patients were treated with either open surgery (n = 9) or an endovascular approach (n = 13). For the open surgical patients, hypothermic circulatory arrest (n = 7) or left heart bypass (n = 2) was used. For those patients undergoing an endovascular approach (n = 13), carotid to subclavian arterial bypasses were performed preoperatively in 11 patients and intraoperatively in 2 patients. Bilateral revascularization was more frequently performed with endovascular repair compared with open surgery (69% vs 22%, p = 0.01).


RESULTS
Early outcomes included in-hospital mortality (n = 1), stroke (n = 1), and permanent spinal cord ischemia (n = 1) after endovascular approaches, and renal failure requiring dialysis (n = 1) and need for tracheostomy (n = 1) after open repair. The frequency of endovascular repair increased after the commercialization of thoracic endovascular aortic repair in 2005 from 33% to 63%. Four patients developed type I (n = 1) or type II (n = 3) endoleaks, of which 1 required reintervention. Median hospital stay was 7 days (interquartile range 4 to 17). Five-year survival was 81.8%. No late aortic ruptures occurred and 3 patients required late reintervention; 1 after an open and 2 after an endovascular approach. Dysphagia lusoria was relieved in all patients except for 1 in the open repair and 1 in the endovascular group.


CONCLUSIONS
Aberrant subclavian arteries and associated Kommerell diverticulum can be treated with acceptable rates of mortality and morbidity. The evolution toward an endovascular approach did not appear to affect late outcomes, suggesting that the choice of treatment should be based on patient-specific anatomy and associated comorbidities.
Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan.
Guido H W
GH
van Bogerijen
Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan. Electronic address: hjpatel@med.umich.edu.
Himanshu J
HJ
Patel
Department of Vascular Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan.
Jonathan L
JL
Eliason
Department of Vascular Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan.
Enrique
E
Criado
Department of Radiology, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan.
David M
DM
Williams
Department of Vascular Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan.
Jordan
J
Knepper
Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan.
Bo
B
Yang
Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan.
G Michael
GM
Deeb
D000783:Aneurysm / Q000150:complications / Q000601:surgery*; D001013:Aorta, Thoracic / Q000002:abnormalities* / Q000601:surgery*; D001018:Aortic Diseases / Q000209:etiology / Q000601:surgery*; D018376:Cardiovascular Abnormalities / Q000150:complications / Q000601:surgery*; D003680:Deglutition Disorders / Q000150:complications / Q000601:surgery*; D004240:Diverticulum / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013348:Subclavian Artery / Q000002:abnormalities* / Q000601:surgery