Gunga Ziyad, Rousseau Lorène, Wolff Margaux, Rigollot Augustin, Nowacka Anna, Dulgorov Filip, Ltaief Zied, Rancati Valentina, Trunfio Rafael, Déglise Sebastien, Kirsch Matthias
Cardiac Surgery Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
Anesthesiology Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
Front Cardiovasc Med. 2025 Apr 7;12:1557293. doi: 10.3389/fcvm.2025.1557293. eCollection 2025.
Arteria lusoria (AL), an anomaly of the right subclavian artery, occurs in 2% of individuals and can cause symptoms such as dysphagia due to its retroesophageal course. Often associated with Kommerell's diverticulum (KD), a dilation at the artery's origin, this condition poses risks of rupture or dissection. Symptomatic cases and aneurysms necessitate surgical intervention, while asymptomatic cases may warrant observation. We present a case of a 44-year-old woman with dysphagia lusoria due to AL and KD, confirmed by imaging. Given anatomical complexities, a one-stage open surgical repair via sternotomy was performed. This involved resecting the KD and creating a neo-trajectory for the right subclavian artery using a Dacron tube graft. Cardiopulmonary bypass ensured safe manipulation, and post-operative imaging confirmed excellent outcomes, with complete symptom resolution. Surgical approaches for AL and KD vary depending on anatomy and symptomatology, ranging from open repairs to hybrid and endovascular techniques. Open thoracotomy remains the gold standard for young patients without comorbidities. Hybrid approaches are reserved for emergencies or high-risk patients, offering reduced morbidity but potentially higher complication rates. Advances in imaging and surgical techniques, including hybrid methods, have improved outcomes, with mortality rates significantly lower than historical benchmarks. The 2024 EACTS/STS guidelines recommend open surgery for young, fit patients (Class I, Level C) and hybrid approaches for emergencies or patients unfit for open surgery (Class I, Level C). Our case exemplifies the feasibility of sternotomy in providing precise, effective correction for KD with AL in a single operation while minimizing risks associated with other approaches.
迷走动脉（AL）是右锁骨下动脉的一种异常情况，在2%的个体中出现，因其走行于食管后方可导致吞咽困难等症状。它常与Kommerell憩室（KD）相关，后者是动脉起始处的扩张，这种情况存在破裂或夹层的风险。有症状的病例和动脉瘤需要手术干预，而无症状的病例可能需要观察。我们报告一例44岁女性因迷走动脉和Kommerell憩室导致吞咽困难的病例，经影像学检查确诊。鉴于解剖结构复杂，通过胸骨切开术进行了一期开放手术修复。这包括切除Kommerell憩室，并使用涤纶人工血管为右锁骨下动脉创建新的走行路径。体外循环确保了安全操作，术后影像学检查证实效果极佳，症状完全缓解。迷走动脉和Kommerell憩室的手术方法因解剖结构和症状而异，从开放修复到杂交和血管内技术不等。对于没有合并症的年轻患者，开胸手术仍然是金标准。杂交方法适用于紧急情况或高危患者，可降低发病率，但潜在并发症发生率可能更高。影像学和手术技术的进步，包括杂交方法，改善了治疗效果，死亡率显著低于历史基准。2024年欧洲心胸外科学会/美国胸外科医师学会指南建议，对于年轻、健康的患者采用开放手术（I类，C级），对于紧急情况或不适合开放手术的患者采用杂交方法（I类，C级）。我们的病例例证了胸骨切开术在单次手术中为伴有迷走动脉的Kommerell憩室提供精确、有效矫正的可行性，同时将与其他方法相关的风险降至最低。
