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右侧主动脉弓合并Kommerell憩室的最佳手术策略：四例报告

Optimal Surgical Strategy for Kommerell's Diverticulum Associated with a Right-Sided Aortic Arch: A Report of Four Cases.

作者信息

Tamai Yumeka, Ogawa Tatsuya, Hamada Ryusuke, Sakaguchi Genichi

机构信息

Department of Cardiovascular Surgery, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan.

出版信息

Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.25-0049. Epub 2025 Jun 18.

DOI:10.70352/scrj.cr.25-0049
PMID:40625544
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12229790/
Abstract

INTRODUCTION

Kommerell's diverticulum is often associated with a right-sided aortic arch. It presents as a saccular aneurysm. Although various surgical strategies have been reported, optimal treatment has not been established.

CASE PRESENTATION

Four patients with right-sided aortic arch underwent different surgeries for Kommerell's diverticulum. The pattern of aortic arch was a mirror-image of the normal left aortic arch in Cases 1 and 2. In Cases 3 and 4, it was right-sided aortic arch with an aberrant left subclavian artery as its last branch. Cases 1 and 3 presented with compression symptoms caused by Kommerell's diverticulum. They underwent open surgery or thoracic endovascular aortic repair through the different approaches. Their postoperative courses were favorable.

CONCLUSIONS

The surgical strategy for Kommerell's diverticulum with a right-sided aortic arch should be selected based on the anatomical characteristics of the cervical vessels, compression symptoms, and surgical risks.

摘要

引言

Kommerell憩室常与右侧主动脉弓相关联。它表现为囊状动脉瘤。尽管已报道了各种手术策略，但尚未确定最佳治疗方法。

病例报告

4例右侧主动脉弓患者因Kommerell憩室接受了不同的手术。病例1和病例2中主动脉弓的形态是正常左主动脉弓的镜像。病例3和病例4中，是右侧主动脉弓，其最后一个分支为异常的左锁骨下动脉。病例1和病例3出现了由Kommerell憩室引起的压迫症状。他们通过不同的方法接受了开放手术或胸主动脉腔内修复术。他们的术后病程顺利。

结论

对于伴有右侧主动脉弓的Kommerell憩室的手术策略，应根据颈部血管的解剖特征、压迫症状和手术风险来选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0716/12229790/9becb6a0f7ea/scr-11-01-25-0049-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0716/12229790/a5ed5c95b52b/scr-11-01-25-0049-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0716/12229790/c06d9ea9ef4f/scr-11-01-25-0049-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0716/12229790/313f205b56db/scr-11-01-25-0049-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0716/12229790/771edfa5e623/scr-11-01-25-0049-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0716/12229790/9becb6a0f7ea/scr-11-01-25-0049-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0716/12229790/a5ed5c95b52b/scr-11-01-25-0049-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0716/12229790/c06d9ea9ef4f/scr-11-01-25-0049-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0716/12229790/313f205b56db/scr-11-01-25-0049-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0716/12229790/771edfa5e623/scr-11-01-25-0049-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0716/12229790/9becb6a0f7ea/scr-11-01-25-0049-g005.jpg

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JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection.《日本循环学会/日本心血管外科学会/日本胸外科学会/日本血管外科学会2020年主动脉瘤和主动脉夹层诊断与治疗指南》
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A systematic review of open, hybrid, and endovascular repair of aberrant subclavian artery and Kommerell's diverticulum treatment.
对异常锁骨下动脉和 Kommerell 憩室治疗的开放式、杂交式和血管内修复的系统评价。
J Vasc Surg. 2023 Feb;77(2):642-649.e4. doi: 10.1016/j.jvs.2022.07.010. Epub 2022 Jul 15.
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A Systematic Review of Total Thoracic Endovascular Aortic Repair in Treatment of Kommerell Diverticulum Combined with Right-Sided Aortic Arch.Kommerell 憩室合并右侧主动脉弓的全胸腔镜主动脉修复的系统评价
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