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Kommerell's diverticulum in the current era: a comprehensive review
Akiko Tanaka1, Ross Milner, Takeyoshi Ota
1Department of Surgery, Section of Cardiac and Thoracic Surgery, University of Chicago, 5841 Maryland Avenue, Suite E-500/MC5040, Chicago, IL, 60637, USA.
General Thoracic and Cardiovascular Surgery
|February 1, 2015
Summary
Kommerell's diverticulum, a remnant of the fourth dorsal aortic arch, presents with varied symptoms in pediatric and adult patients. Early intervention is increasingly favored for this condition, especially when specific size criteria are met.
Area of Science:
- Vascular Surgery
- Congenital Cardiovascular Anomalies
- Radiology
Background:
- Kommerell's diverticulum is a rare congenital anomaly arising from the fourth dorsal aortic arch.
- It can affect both left and right aortic arches, often associated with an aberrant subclavian artery.
- Clinical presentation varies, with airway issues in children and dysphagia/chest discomfort in adults.
Purpose of the Study:
- To review the current understanding of Kommerell's diverticulum.
- To discuss diagnostic imaging, histological findings, and management strategies.
- To summarize outcomes of surgical and endovascular interventions.
Main Methods:
- Review of literature from 2004-2014 focusing on Kommerell's diverticulum.
- Analysis of diagnostic imaging (CT/MRI) and histological findings.
- Compilation of data on open and endovascular repair outcomes for over 210 cases.
Main Results:
- Histological studies reveal cystic medial necrosis, explaining high rates of aortic dissection/rupture.
- Surgical intervention is generally considered for diverticulum orifice >30 mm or descending aorta >50 mm.
- Treatment options include open repair, hybrid, and total endovascular repair.
Conclusions:
- Advancements in imaging and treatment strategies support earlier, more aggressive intervention for Kommerell's diverticulum.
- Treatment selection depends on patient anatomy, comorbidities, and available surgical expertise.
- Evidence from over 210 cases informs current management approaches.
