Liu Can, Wang Chen, Bao Jie, Liu Min, Liu Jiabin, Cao Lizhen, Du Xiangying, Lu Jie
Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.
Quant Imaging Med Surg. 2025 Jun 6;15(6):5621-5634. doi: 10.21037/qims-2024-2547. Epub 2025 May 20.
The management of patients with asymptomatic Kommerell diverticulum (KD) with aberrant left subclavian artery (ALSA) has been controversial due to a lack of knowledge about the natural history. We aimed to explore the size and growth pattern of KD and its relationship with age and sex.
This was a single-center observational retrospective study focused on KD with ALSA patients incidentally diagnosed via computed tomography (CT) scans. Measurements on KD in all dimensions, diameters of ascending and descending aorta (AAo and DAo), and distal left subclavian artery (dLSA) were performed. Clinical and demographic features were collected using the medical records system. Follow-up information was also collected. Correlations between age and KD measurements were analyzed across different genders. A comparison of the demographic features between potential surgical candidates, according to the present criteria, and other cases was performed.
A total of 67 KD patients (mean age 53.8±14.5 years) were included. There were 42 males (62.7%) and 25 females (37.3%). The average sizes of KDs, AAo, DAo, and dLSA were larger in males. A positive correlation was found between KD size and age in females (P<0.05), which was insignificant in males. There were no correlations between age and KD measurements indexed to AAo, DAo, or dLSA in both males and females (P>0.05). The median follow-up period was 50 months (ranging from 5 to 129 months). Most patients (95.5%) had no symptoms or deadly vascular events related to KD during follow-up, with only three male patients having died from pulmonary infection or heart failure. Potential surgical candidates were significantly older than non-potential surgical candidates (P=0.004).
Patients incidentally diagnosed with asymptomatic KD with ALSA tend to have a benign natural history, and related major vascular events are rare in the short term. In cases with large KD and severe atherosclerosis, regular imaging and clinical follow-up would be suggested.
由于对无症状Kommerell憩室（KD）合并异常左锁骨下动脉（ALSA）患者的自然病史缺乏了解，其治疗一直存在争议。我们旨在探讨KD的大小和生长模式及其与年龄和性别的关系。
这是一项单中心观察性回顾性研究，聚焦于通过计算机断层扫描（CT）扫描偶然诊断出的KD合并ALSA患者。对KD的所有维度、升主动脉和降主动脉（AAo和DAo）的直径以及左锁骨下动脉远端（dLSA）进行测量。使用病历系统收集临床和人口统计学特征。还收集随访信息。分析不同性别中年龄与KD测量值之间的相关性。根据当前标准，对潜在手术候选者与其他病例的人口统计学特征进行比较。
共纳入67例KD患者（平均年龄53.8±14.5岁）。其中男性42例（62.7%），女性25例（37.3%）。男性的KD、AAo、DAo和dLSA的平均尺寸更大。女性中KD大小与年龄呈正相关（P<0.05），男性中无显著相关性。男性和女性中年龄与以AAo、DAo或dLSA为指标的KD测量值均无相关性（P>0.05）。中位随访期为50个月（范围为5至129个月）。大多数患者（95.5%）在随访期间没有与KD相关的症状或致命血管事件，只有3例男性患者死于肺部感染或心力衰竭。潜在手术候选者明显比非潜在手术候选者年龄大（P = 0.004）。
偶然诊断出的无症状KD合并ALSA患者往往具有良性自然病史，短期内相关的主要血管事件很少见。对于KD较大且存在严重动脉粥样硬化的病例，建议进行定期影像学和临床随访。
