Involvement of Kommerell's diverticulae-a new anatomical risk factor for acute aortic syndrome progression and technical considerations

Victoria Cook; Animesh A Singla; David Herlihy; Juanita Chui; Charles Fisher; Vikram Puttaswamy

doi:10.1093/jscr/rjac489

Involvement of Kommerell's diverticulae-a new anatomical risk factor for acute aortic syndrome progression and technical considerations

J Surg Case Rep. 2022 Oct 30;2022(10):rjac489. doi: 10.1093/jscr/rjac489. eCollection 2022 Oct.

Authors

Victoria Cook¹, Animesh A Singla^{1

2}, David Herlihy¹, Juanita Chui^{1

2}, Charles Fisher¹, Vikram Puttaswamy¹

Affiliations

¹ Department of Vascular Surgery, Royal North Shore Hospital, Sydney, NSW 2065, Australia.
² Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2065, Australia.

Abstract

We present two cases of acute aortic syndromes (AAS), involving an aberrant right subclavian artery (ARSA) with associated Kommerell's diverticulae (KD). One of the cases involves a penetrating aortic ulcer in patients with an ARSA and KD and represents the first reported such case in the literature. Both cases progressed despite optimal medical therapy suggesting AAS with this anomalous anatomy needs a more aggressive operative approach. The involvement of KD in a patient with AAS appears to increase aortic disease progression and this anatomical variation should be considered another anatomical criterion that may place these patients at higher risk of complication. Progression during conservative management and waiting for the patient to be in the traditional safer 'sub-acute' time frame after presentation increased the eventual difficulty of the hybrid repair. A hybrid open-endovascular repair was utilized in all cases and is a safe and effective strategy for managing patients with ARSA and KD presenting with AAS.

Keywords: Aberrant Subclavian; Kommerell’s diveriticulum; TEVAR; acute aortic syndrome; type b aortic dissection.

Publication types

Case Reports