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Guido H. W. van Bogerijen, MD, Himanshu J. Patel, MD, Jonathan L

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Presentation on theme: "Guido H. W. van Bogerijen, MD, Himanshu J. Patel, MD, Jonathan L"— Presentation transcript:

1 Evolution in the Management of Aberrant Subclavian Arteries and Related Kommerell Diverticulum 
Guido H.W. van Bogerijen, MD, Himanshu J. Patel, MD, Jonathan L. Eliason, MD, Enrique Criado, MD, David M. Williams, MD, Jordan Knepper, MD, Bo Yang, MD, PhD, G. Michael Deeb, MD  The Annals of Thoracic Surgery  Volume 100, Issue 1, Pages (July 2015) DOI: /j.athoracsur Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

2 Fig 1 This 58-year-old female patient presented with subacute type B intramural hematoma and aberrant right subclavian artery and was treated with bilateral carotid-subclavian arterial bypasses and thoracic endovascular aortic repair (TEVAR). (A) Three-dimensional (3D) reconstruction of the preoperative situation; the aberrant right subclavian artery originates as fourth supra-aortic vessel from the dorsal side of the thoracic aorta. (B) After bilateral subclavian artery revascularization and TEVAR, this 3D reconstruction shows successful exclusion of both subclavian artery origins. The Annals of Thoracic Surgery  , 47-53DOI: ( /j.athoracsur ) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

3 Fig 2 This 63-year-old male patient presented with dysphagia lusoria caused by an aberrant right subclavian artery and Kommerell diverticulum with tracheoesophageal compression. (A) Preoperative three-dimensional (3D) reconstruction demonstrates a bovine trunk and an aberrant right subclavian artery that emanates as last supra-aortic vessel from the dorsal side of the thoracic aorta. (B) Preoperative computed tomographic imaging shows that the aberrant right subclavian artery with Kommerell diverticulum (18 mm) crossing the midline causes tracheoesophageal compression. (C) Post TEVAR 3D reconstruction shows exclusion of the aberrant right subclavian artery. The Annals of Thoracic Surgery  , 47-53DOI: ( /j.athoracsur ) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

4 Fig 3 This 34-year-old male patient with right-sided aortic arch, complete vascular ring, and progressive dysphagia lusoria was treated with bilateral subclavian artery revascularization followed by TEVAR. (A) Preoperative three-dimensional reconstruction of the aorta shows the Kommerell diverticulum (22 mm) of the aberrant left subclavian artery. (B) Preoperative computed tomographic (CT) imaging shows the right-sided aortic arch with vascular ring. (C) Post TEVAR CT imaging shows an intact vascular ring, but excluded Kommerell diverticulum. This patient had persisting dysphagia and underwent therefore division of his ligamentum arteriosum to relieve the vascular ring. Despite this second intervention, his symptoms persisted and further evaluation suggested esophageal dysmotility, potentially caused by longstanding esophageal obstruction, as the etiology of his complaints. The Annals of Thoracic Surgery  , 47-53DOI: ( /j.athoracsur ) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

5 Fig 4 The evolution toward endovascular and hybrid approaches is demonstrated, with 80% of the procedures for the management of aberrant subclavian arteries and related Kommerell diverticulum being endovascular or hybrid approaches in the last 5 years (2010 to 2014). The Annals of Thoracic Surgery  , 47-53DOI: ( /j.athoracsur ) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

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