Key result
Hybrid open-endovascular repair successfully treated two patients with acute aortic syndromes involving an aberrant right subclavian artery and Kommerell's diverticulae who progressed despite optimal medical therapy.
Why the study?
Does hybrid open-endovascular repair improve outcomes compared to conservative management in patients with acute aortic syndromes involving Kommerell's diverticulae?
Case Report (n=2)
Does hybrid open-endovascular repair improve outcomes compared to conservative management in patients with acute aortic syndromes involving Kommerell's diverticulae?
In patients with acute aortic syndromes and Kommerell's diverticulae, conservative management may lead to disease progression, suggesting early hybrid open-endovascular repair should be considered.
Progression despite medical therapy in these cases leaves open whether early hybrid repair improves outcomes; prospective studies required.
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.
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Cook et al. (2022) conducted a case report in Acute aortic syndrome involving an aberrant right subclavian artery and Kommerell's diverticulae (n=2). Hybrid open-endovascular repair vs. Conservative management (initial trial) was evaluated on Successful repair and resolution of symptoms. Hybrid open-endovascular repair successfully treated two patients with acute aortic syndromes involving an aberrant right subclavian artery and Kommerell's diverticulae who progressed despite optimal medical therapy.
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