Re: 'endovascular repair of a right-sided thoracic aortic aneurysm with kommerell diverticulum and aberrant left subclavian artery'

摘要

In their recent article, Monaco et al. describe an interesting case of successful total endovascular repair of right-sided descending thoracic aorta aneurysm with Kom-merell diverticulum and aberrant left subclavian artery. Aberrant right subclavian artery occurs in ~0.5-1.0% of the population. Instead, aberrant left subclavian artery arising from a right aortic arch is less common. Kommerell diverticulum is present in up to 60% of patients with an aberrant subclavian artery. Aneurysms of the diverticulum have been observed in 3-8% of patients. These aneurysms can cause serious complications, which include distal embolization, compression of adjacent structures, dissection, and rupture. A number of surgical techniques have been proposed for treatment of these aneurysms with or without use of partial or total cardio-pulmonary bypass, hypothermia, and circulatory arrest. However, a specific strategy for surgical treatment of Kommerell diverticulum has not yet been established. Surgical mortality used to be as high as 16.6%, except for rupture. The endovascular treatment of this thoracic aortic pathology is feasible and less invasive. If the proximal landing zone for the thoracic stent graft is proximal to the origin of the left subclavian artery, the combined (surgical and endovascular) procedure is necessary for supra-aortic trunk revascularization. However, we agree with the authors who believe that the auxiliary surgical revascularization should be reserved for those patients who develop ischemic symptoms or who have a potentially compromised collateral arm supply (previous aortocoro-nary bypass surgery with use of the left internal mammary artery, critically stenosed carotid or vertebral arteries, or both, or a functionally compromised circle of Willis).