Unit:
Speciality Endovascular TechniquesLibrary of the School of Health Sciences
Author:
Kalampalikis Lazaros
Supervisors info:
Γεώργιος Γερουλάκος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ, Επιβλέπων
Ιωάννης Κακίσης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Αχιλλέας Χατζηϊωάννου, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Kommerell’s diverticulum: a rare congenital variant with a “lusorian” optimal treatment – a literature review.
Translated title:
Kommerell’s diverticulum: a rare congenital variant with a “lusorian” optimal treatment – a literature review.
Summary:
Objective: Kommerell’s diverticulum is a rare congenital anomaly of the aortic arch vasculature – and is defined as an arterial distention located at the base of the subclavian arteries, in both left- and right-sided aortic arches. In spite of its rarity, its clinical relevance is high and should be included in the differential diagnosis of tracheal and esophageal compressive symptoms. Traditionally, open surgery is considered the favored surgical treatment. As operative techniques evolve, the option of totally endovascular or hybrid treatment for aortic aneurysms seems a viable alternative to the open surgical approach. The objective of this study is to review the current literature and describe the possible approaches of surgical treatment for Kommerell’s diverticulum.
Method: For this review, a search in PUBMED database for reports related to Kommerell’s diverticulum and aberrant arterial branches of the aortic arch revealed a number of articles. Further cross-reference of the articles retrieved was also examined. To the best of our knowledge, no large randomized control trial is yet conducted and the surgical experience in the current literature derives from limited single-center series and isolated case reports.
Results: Due to the rarity and the complexity of the pathology related to Kommerell’s diverticulum, the sample examined in this review presents great heterogeneity of the demographic data and clinical presentation, as well as of the preferred treatment. However, all the available studies in the literature conclude that Kommerell’s diverticulum manifests with compressive symptoms mainly from the trachea and esophagus, presents an average size of 4 cm and the hybrid surgical approach (Thoracic Endovascular Aneurysm Repair and open surgical revascularization of the aberrant subclavian artery – as a single or a double stage procedure) is the most common surgical treatment, with satisfying long term results and low rate of complications in experienced centers.
Conclusion: Aortic aneurysms present a diagnostic and therapeutic challenge. The addition of an anomalous anatomy of the aortic branches further complicates the surgical approach. The hybrid approach seems to be the most effective treatment of the aneurysmal origin of aberrant arterial branches of the arch and the experience gained predestinates a complete endovascular treatment. Additional studies are needed to prove and establish the feasibility and efficacy of modern endovascular techniques for the treatment of Kommerell’s diverticulum.
Main subject category:
Health Sciences
Keywords:
Kommerell's diverticulum, Aortic aneurysms, Aberrant subclavian artery
File:
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Kommerell's diverticulum Kalampalikis Lazaros.pdf
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