Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Vascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
J Thorac Cardiovasc Surg. 2014 Mar;147(3):973-6. doi: 10.1016/j.jtcvs.2013.02.063. Epub 2013 Mar 25.
Kommerell diverticulum carries the risk of rupture or dissection if left untreated. Various methods of repair have been described, and options have recently expanded to include the hybrid approach. This study describes hybrid repair techniques for Kommerell diverticulum and assesses outcomes.
Between 2005 and 2010, a total of 10 patients underwent hybrid repair of Kommerell diverticulum (3 right-sided arches) by elephant trunk with endovascular completion (n = 4), frozen elephant trunk (n = 3), or stent grafting with cervical debranching (n = 3). Mean age at procedure was 57 ± 25.5 years. Subclavian artery revascularization was performed preoperatively (n = 4), intraoperatively (n = 3), or postoperatively (n = 3), either as carotid-to-subclavian bypass (n = 7; n = 3 bilateral) or originating from the ascending aorta (n = 3). Data were obtained from the prospectively collected database and chart review.
There was no in-hospital mortality, nor were there any cases of respiratory or renal failure. There were no cases of paraplegia, but there was 1 stroke. Two patients had type 2 endoleaks develop; 1 required subclavian coil embolization. Mean hospital stay was 8.73 ± 4 days. After repair, there were no ruptures, no significant growth, and all patients remain free of symptoms.
Hybrid repair is a safe and effective surgical treatment option for Kommerell diverticulum. Selection of the specific type of intervention is based on patient anatomy and comorbid conditions.
如果 Kommerell 憩室未得到治疗，可能会破裂或夹层。已经描述了各种修复方法，并且最近已经扩展到包括杂交方法。本研究描述了 Kommerell 憩室的杂交修复技术，并评估了其结果。
2005 年至 2010 年间，共有 10 例患者接受了 Kommerell 憩室的杂交修复（3 例右侧弓），通过象鼻手术加血管内完成（n=4），冷冻象鼻手术（n=3），或支架移植加颈部分支（n=3）。手术时的平均年龄为 57±25.5 岁。术前（n=4）、术中（n=3）或术后（n=3）进行锁骨下动脉血运重建，通过颈动脉到锁骨下旁路（n=7；n=3 例双侧）或源自升主动脉（n=3）。数据来自前瞻性收集的数据库和图表审查。
无院内死亡，无呼吸或肾功能衰竭。无截瘫病例，但有 1 例中风。2 例患者出现 2 型内漏，其中 1 例需要锁骨下线圈栓塞。平均住院时间为 8.73±4 天。修复后，无破裂，无明显生长，所有患者症状均消失。
杂交修复是治疗 Kommerell 憩室的一种安全有效的手术治疗选择。选择具体的干预类型取决于患者的解剖结构和合并症。
