TAA 8. Hybrid Repair Techniques for Kommerell Diverticulum, New Aortic Arch Classification, Early and Late Results

Giovanni Tinelli, Yamume Tshomba, Ciro Ferrer, Rocco Giudice, Marco Ferraresi, Gabriele Pogany, Piergiorgio Cao

Research output: Contribution to journalConference article

Abstract

Objective: The aim of this study was to evaluate early and late results of hybrid repair techniques for Kommerell diverticulum (KD). Methods: All patients undergoing hybrid repair (thoracic endovascular aortic repair + supra-aortic debranching) for KD between 2009 and 2018 were included in this retrospective multicenter study (three Italian cen- ters). A proximal landing zone (PLZ) of at least 2 cm of healthy aorta was considered adequate for the deployment of a standard thoracic stent graft. The early end points were technical success, in-hospital mor- tality, and cerebrovascular events. Late outcomes included survival, rein- tervention, and patency of supra-aortic debranching. We proposed an embryogenetic anomaly-based aortic arch classification for PLZ evalua- tion to choose the most appropriate hybrid adjunct (Fig). Results: Sixteen patients with KD were included. According to the aforementioned classification, six patients (37.5%) required stent graft deployment in PLZ 0, nine (56.3%) in PLZ 1, and one (6.3%) in PLZ 2. Tech- nical success was achieved in all patients. One patient (6.3%) died in the hospital of posterior cerebral hemorrhage after a total debranching (PLZ 0). No other cerebrovascular event was registered. One patient (6.3%) re- ported an asymptomatic right subclavian artery-left subclavian artery bypass occlusion and required an early reintervention. The 30-day pri- mary assisted patency of supra-aortic debranching was 100% (Table I). Two type II endoleaks (12.5%) were detected at 1-month computed to- mography angiography. Further transient complications were registered in three cases: hemidiaphragm paralysis in one patient and recurrent laryngeal nerve paralysis in two patients. At a mean follow-up of 48 months, four patients died of non-aorta-related reasons and one right common carotid artery-right subclavian artery bypass lost its patency. Ten patients (62.5%) presented with aneurysmal sac shrinkage of at least 5 mm (Table II). Conclusions: Hybrid repair has been confirmed to be a safe and effec- tive approach for KD. Operative risk is mostly related to the invasiveness of the hybrid adjunct.
Original languageEnglish
Pages (from-to)e150-e151
JournalJournal of Vascular Surgery
Volume70
DOIs
Publication statusPublished - 2019
Event2019 VEITHsymposium Associate Faculty Global Podium Presentations Program - NEW YORK -- USA
Duration: 19 Nov 201921 Mar 2020

Keywords

  • Kommerell Diverticulum

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