Fisher R G, Whigham C J, Trinh C
Department of Radiology-BCM 360, Baylor College of Medicine, Houston, Texas, USA.
Cardiovasc Intervent Radiol. 2005 Sep-Oct;28(5):553-60. doi: 10.1007/s00270-003-0229-0.
This is a retrospective evaluation of the incidence of aberrant subclavian arteries (ASAs) and diverticula of Kommerell, as well as the occurrence and significance of associated aneurysms. Thoracic aortograms obtained during a 12.5-year period were reviewed, seeking the presence of aberrant right and left subclavian arteries (ARSAs/ALSAs), diverticula of Kommerell, and the incidence of associated aortic aneurysms. Several cases were evaluated with computed tomography concomitantly. Results were correlated with a literature review. Twenty-two ASAs were identified. Nineteen were on the right (ARSAs) and three were on the left (ALSAs). A diverticulum of Kommerell (DOK) was also present on the right in seven and on the left in three. Five of these patients had complicating aneurysms. Four of these were associated with ARSAs and their diverticula. Two were atherosclerotic; one was a limited dissection and one of uncertain etiology was ruptured. One additional aneurysm (atherosclerotic) involved an ALSA/DOK. The patient with the ruptured aneurysm died in surgery; three were managed conservatively because of concomitant disease; and one is being followed because of the small size (2.5 cm) of the aneurysm. ARSAs are relatively uncommon and ALSAs are rare. Both ARSA and ALSA are frequently associated with a DOK. Aneurysms rarely involve ASAs (with or without a DOK), but they are associated with a high mortality rate if they are not discovered before rupture. Early diagnosis plus surgical and/or endovascular management can be lifesaving.
这是一项对迷走锁骨下动脉（ASAs）和Kommerell憩室的发生率，以及相关动脉瘤的发生情况和意义的回顾性评估。回顾了在12.5年期间获得的胸部主动脉造影，以寻找迷走右锁骨下动脉（ARSAs）和迷走左锁骨下动脉（ALSAs）、Kommerell憩室以及相关主动脉瘤的发生率。同时对几例患者进行了计算机断层扫描评估。结果与文献综述进行了对比。共识别出22例ASAs。其中19例为右侧（ARSAs），3例为左侧（ALSAs）。右侧有7例存在Kommerell憩室（DOK），左侧有3例。这些患者中有5例合并有动脉瘤。其中4例与ARSAs及其憩室相关。2例为动脉粥样硬化性；1例为局限性夹层，1例病因不明的动脉瘤破裂。另外1例动脉瘤（动脉粥样硬化性）累及ALSA/DOK。动脉瘤破裂的患者在手术中死亡；3例因合并其他疾病而采取保守治疗；1例因动脉瘤较小（2.5 cm）而进行随访。ARSAs相对不常见，ALSAs则罕见。ARSAs和ALSAs都常与DOK相关。动脉瘤很少累及ASAs（无论有无DOK），但如果在破裂前未被发现，则死亡率很高。早期诊断加上手术和/或血管内治疗可挽救生命。
