Contemporary outcomes after treatment of aberrant subclavian artery and Kommerell's diverticulum

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Bath, JonathanUniv Missouri, Div Vasc Surg, Columbia, MO 65212 USA. (author)

Contemporary outcomes after treatment of aberrant subclavian artery and Kommerell's diverticulum

Article/chapterEnglish2023

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Elsevier BV,2023
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LIBRIS-ID:oai:DiVA.org:uu-509151
https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-509151URI
https://doi.org/10.1016/j.jvs.2023.01.014DOI

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Language:English
Summary in:English

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Subject category:art swepub-publicationtype

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Objective: Aberrant subclavian artery (ASA) and Kommerell's diverticulum (KD) are rare vascular anomalies that may be associated with lifestyle-limiting and life-threatening complications. The aim of this study is to report contemporary outcomes after invasive treatment of ASA/KD using a large international dataset.Methods: Patients who underwent treatment for ASA/KD (2000-2020) were identified through the Vascular Low Frequency Disease Consortium, a multi-institutional collaboration to investigate uncommon vascular disorders. We report the early and mid-term clinical outcomes including stroke and mortality, technical success, and other operative outcomes including reintervention rates, patency, and endoleak.Results: Overall, 285 patients were identified during the study period. The mean patient age was 57 years; 47% were female and 68% presented with symptoms. A right-sided arch was present in 23%. The mean KD diameter was 47.4 mm (range, 13.0-108.0 mm). The most common indication for treatment was symptoms (59%), followed by aneurysm size (38%). The most common symptom reported was dysphagia (44%). A ruptured KD was treated in 4.2% of cases, with a mean diameter of 43.9 mm (range, 18.0-100.0 mm). An open procedure was performed in 101 cases (36%); the most common approach was ASA ligation with subclavian transposition. An endovascular or hybrid approach was performed in 184 patients (64%); the most common approach was thoracic endograft and carotid-subclavian bypass. A staged operative strategy was employed more often than single setting repair (55% vs 45%). Compared with endovascular or hybrid approach, those in the open procedure group were more likely to be younger (49 years vs 61 years; P < .0001), female (64% vs 36%; P < .0001), and symptomatic (85% vs 59%; P < .0001). Complete or partial symptomatic relief at 1 year after intervention was 82.6%. There was no association between modality of treatment and symptom relief (open 87.2% vs endovascular or hybrid approach 78.9%; P = .13). After the intervention, 11 subclavian occlusions (4.5%) occurred; 3 were successfully thrombectomized resulting in a primary and secondary patency of 95% and 96%, respectively, at a median follow-up of 39 months. Among the 33 reinterventions (12%), the majority were performed for endoleak (36%), and more reinterventions occurred in the endovascular or hybrid approach than open procedure group (15% vs 6%; P = .02). The overall survival rate was 87.3% at a median follow-up of 41 months. The 30-day stroke and death rates were 4.2% and 4.9%, respectively. Urgent or emergent presentation was independently associated with increased risk of 30-day mortality (odds ratio [OR], 19.8; 95% confidence interval [CI], 3.3-116.6), overall mortality (OR, 3.6; 95% CI, 1.2-11.2) and intraoperative complications (OR, 8.3; 95% CI, 2.8-25.1). Females had a higher risk of reintervention (OR, 2.6; 95% CI, 1.0-6.5). At an aneurysm size of 44.4 mm, receiver operator characteristic curve analysis suggested that 60% of patients would have symptoms.Conclusions: Treatment of ASA/KD can be performed safely with low rates of mortality, stroke and reintervention and high rates of symptomatic relief, regardless of the repair strategy. Symptomatic and urgent operations were associated with worse outcomes in general, and female gender was associated with a higher likelihood of reintervention. Given the worse overall outcomes when symptomatic and the inherent risk of rupture, consideration of repair at 40 mm is reasonable in most patients. ASA/KD can be repaired in asymptomatic patients with excellent outcomes and young healthy patients may be considered better candidates for open approaches versus endovascular or hybrid modalities, given the lower likelihood of reintervention and lower early mortality rate.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kardiologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Cardiac and Cardiovascular Systems hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kirurgi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Surgery hsv//eng

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Univ Missouri, Div Vasc Surg, Columbia, MO 65212 USA.Univ Hosp Trieste ASUGI, Cardiovasc Dept, Div Vasc & Endovasc Surg, Trieste, Italy. (creator_code:org_t)

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In:Journal of Vascular Surgery: Elsevier BV77:5, s. 1339-1348.e60741-52141097-6809

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By the author/editor: Bath, Jonathan; D'Oria, Mario; Rogers, Richard ...; Colglazier, Jill ...; Braet, Drew J.; Coleman, Dawn M.; show more...; Scali, Salvatore ...; Back, Martin R.; Magee, Gregory A ...; Plotkin, Anastas ...; Dueppers, Philip; Zimmermann, Alex ...; Affi, Rana O.; Khan, Sophia; Zarkowsky, Devin; Dyba, Gregory; Soult, Michael C ...; Mani, Kevin, 197 ...; Wanhainen, Ander ...; Setacci, Carlo; Lenti, Massimo; Kabbani, Loay S.; Weaver, Mitchell ...; Bissacco, Daniel ...; Trimarchi, Santi; Stoecker, Jordan ...; Wang, Grace J.; Szeberin, Zoltan; Pomozi, Eniko; Moffatt, Clare; Gelabert, Hugh A ...; Tish, Shahed; Hoel, Andrew W.; Cortolillo, Nich ...; Spangler, Emily ...; Passman, Marc A.; De Caridi, Giova ...; Benedetto, Filip ...; Zhou, Wei; Abuhakmeh, Youse ...; Newton, Daniel H ...; Liu, Christopher ...; Tinelli, Giovann ...; Tshomba, Yamume; Katoh, Airi; Siada, Sammy S.; Khashram, Manar; Gormley, Sinead; Mullins, John R.; Schmittling, Zac ...; Maldonado, Thoma ...; Politano, Amani ...; Rynio, Pawel; Kazimierczak, Ar ...; Gombert, Alexand ...; Jalaie, Houman; Spath, Paolo; Gallitto, Enrico; Czerny, Martin; Berger, Tim; Davies, Mark G.; Stilo, Francesco; Montelione, Nunz ...; Mezzetto, Luca; Veraldi, Gian Fr ...; Lepidi, Sandro; Lawrence, Peter; Woo, Karen; show less...

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