International Multi-Institutional Experience with Presentation and Management of Aortic Arch Laterality in Aberrant Subclavian Artery and Kommerell's Diverticulum
Annals of Vascular Surgery, vol. 95, pp. 23–31
Abstract
BACKGROUND: Aberrant subclavian artery (ASA) with or without Kommerell's diverticulum (KD) is a rare anatomic aortic arch anomaly that can cause dysphagia and/or life-threatening rupture. The objective of this study is to compare outcomes of ASA/KD repair in patients with a left versus right aortic arch. METHODS: Using the Vascular Low Frequency Disease Consortium methodology, a retrospective review was performed of patients ≥18 years old with surgical treatment of ASA/KD from 2000 to 2020 at 20 institutions. RESULTS: 288 patients with ASA with or without KD were identified; 222 left-sided aortic arch (LAA), and 66 right-sided aortic arch (RAA). Mean age at repair was younger in LAA 54 vs. 58 years (P = 0.06). Patients in RAA were more likely to undergo repair due to symptoms (72.7% vs. 55.9%, P = 0.01), and more likely to present with dysphagia (57.6% vs. 39.1%, P < 0.01). The hybrid open/endovascular approach was the most common repair type in both groups. Rates of intraoperative complications, death within 30 days, return to the operating room, symptom relief and endoleaks were not significantly different. For patients with symptom status follow-up data, in LAA, 61.7% had complete relief, 34.0% had partial relief and 4.3% had no change. In RAA, 60.7% had complete relief, 34.4% had partial relief and 4.9% had no change. CONCLUSIONS: In patients with ASA/KD, RAA patients were less common than LAA, presented more frequently with dysphagia, had symptoms as an indication for intervention, and underwent treatment at a younger age. Open, endovascular and hybrid repair approaches appear equally effective, regardless of arch laterality.
Authors 68
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University of California, Los Angeles
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Division of Vascular and Endovascular Surgery, Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
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Division of Vascular Surgery, University of Missouri, Columbia, MO
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Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
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Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
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University of Michigan · Michigan Medicine
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Division of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
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University of Michigan · Michigan Medicine
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Division of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
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University of Florida Health · University of Florida
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Division of Vascular and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL
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University of Florida Health · University of Florida
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Division of Vascular and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL
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University of Southern California
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Division of Vascular and Endovascular Therapy, Department of Surgery, University of Southern California, Los Angeles, CA
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University of Southern California
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Division of Vascular and Endovascular Therapy, Department of Surgery, University of Southern California, Los Angeles, CA
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Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
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Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
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The University of Texas Health Science Center at Houston
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Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, Houston, TX
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The University of Texas Health Science Center at Houston
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Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, Houston, TX
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University of Colorado Anschutz
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Division of Vascular Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
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University of Colorado Anschutz
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Division of Vascular Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
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Loyola University Chicago · Loyola Medicine
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Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Loyola University Chicago, Stritch School of Medicine, Maywood, IL
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Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Division of Vascular and Endovascular Surgery, Department of Medicine, Surgery, and Neurosciences, University of Siena, Siena, Italy
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Division of Vascular and Endovascular Surgery, Department of Medicine, Surgery, and Neurosciences, University of Siena, Siena, Italy
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Henry Ford Health · Henry Ford Hospital
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Division of Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI
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Henry Ford Health · Henry Ford Hospital
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Division of Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI
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Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
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Department of Vascular Surgery, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
Affiliation as printed
Department of Vascular Surgery, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Hospital of the University of Pennsylvania · University of Pennsylvania
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Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
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Hospital of the University of Pennsylvania · University of Pennsylvania
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Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
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Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
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Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
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Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
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Division of Vascular Surgery, University of Missouri, Columbia, MO
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Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
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Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
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University of Alabama at Birmingham
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Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
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University of Alabama at Birmingham
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Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
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Division of Vascular Surgery, Department of Medical Sciences and Morpho-Functional-Imaging, University of Messina, Messina, Italy
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Division of Vascular Surgery, Department of Medical Sciences and Morpho-Functional-Imaging, University of Messina, Messina, Italy
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Division of Vascular Surgery, Department of Surgery, University of Arizona, Tucson, AZ
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Division of Vascular Surgery, Department of Surgery, University of Arizona, Tucson, AZ
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Virginia Commonwealth University · Virginia Commonwealth University Medical Center
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Division of Vascular Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA
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Virginia Commonwealth University · Virginia Commonwealth University Medical Center
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Division of Vascular Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA
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Università Cattolica del Sacro Cuore · Agostino Gemelli University Polyclinic
Affiliation as printed
Unit of Vascular Surgery, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
Unit of Vascular Surgery, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica del Sacro Cuore, Rome, Italy
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Università Cattolica del Sacro Cuore · Agostino Gemelli University Polyclinic
Affiliation as printed
Unit of Vascular Surgery, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
Unit of Vascular Surgery, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica del Sacro Cuore, Rome, Italy
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University of California, San Francisco
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Department of Surgery, University of California San Francisco at Fresno, Fresno, CA
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University of California, San Francisco
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Department of Surgery, University of California San Francisco at Fresno, Fresno, CA
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Department of Surgery, University of Auckland, Waikato, New Zealand
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Department of Surgery, University of Auckland, Waikato, New Zealand
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Division of Vascular Surgery, Department of Surgery, CoxHealth, Springfield, MO
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Division of Vascular Surgery, Department of Surgery, CoxHealth, Springfield, MO
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NYU Langone Health · New York University
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Division of Vascular Surgery, Department of Surgery, New York University Langone Health, New York, NY
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Oregon Health & Science University
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Division of Vascular Surgery, Department of Surgery, Oregon Health and Sciences University, Portland, OR
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Department of Vascular Surgery, Pomeranian Medical University, Szczecin, Poland
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Department of Vascular Surgery, Pomeranian Medical University, Szczecin, Poland
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Universitätsklinikum Aachen · RWTH Aachen University
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Department of Vascular Surgery, European Vascular Center Aachen-Maastricht, University Hospital RWTH Aachen, Aachen, Germany
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Universitätsklinikum Aachen · RWTH Aachen University
Affiliation as printed
Department of Vascular Surgery, European Vascular Center Aachen-Maastricht, University Hospital RWTH Aachen, Aachen, Germany
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Department of Vascular Surgery, University of Bologna, DIMES, Bologna, Italy
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Department of Vascular Surgery, University of Bologna, DIMES, Bologna, Italy
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University of Freiburg · Universitäts-Herzzentrum Freiburg-Bad Krozingen
Affiliation as printed
University Heart Center Freiburg-Bad Krozingen, Clinic for Cardiovascular Surgery, University Clinic Freiburg, Albert-Ludwigs-University Freiburg, Freiburg, Germany
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University of Freiburg · Universitäts-Herzzentrum Freiburg-Bad Krozingen
Affiliation as printed
University Heart Center Freiburg-Bad Krozingen, Clinic for Cardiovascular Surgery, University Clinic Freiburg, Albert-Ludwigs-University Freiburg, Freiburg, Germany
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The University of Texas at San Antonio Health Science Center
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Division of Vascular and Endovascular Surgery, Long School of Medicine, UT Health San Antonio, San Antonio, TX
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Università Campus Bio-Medico · Campus Bio Medico University Hospital
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Operative Research Unit of Vascular Surgery, Department of Medicine and Surgery, University Campus Bio-Medico of Rome, Rome, Italy
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Università Campus Bio-Medico · Campus Bio Medico University Hospital
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Operative Research Unit of Vascular Surgery, Department of Medicine and Surgery, University Campus Bio-Medico of Rome, Rome, Italy
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Azienda Ospedaliera Universitaria Integrata Verona
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Division of Vascular Surgery, Integrated University Hospital of Verona, Verona, Italy
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Azienda Ospedaliera Universitaria Integrata Verona
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Division of Vascular Surgery, Integrated University Hospital of Verona, Verona, Italy
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University of Trieste · Azienda Sanitaria Universitaria Integrata di Trieste
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Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
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Division of Vascular Surgery, University of Missouri, Columbia, MO
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University of California, Los Angeles
Affiliation as printed
Division of Vascular and Endovascular Surgery, Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
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Karen Woo corresponding
University of California, Los Angeles
Affiliation as printed
Division of Vascular and Endovascular Surgery, Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA. Electronic address: kwoo@mednet.ucla.edu
Division of Vascular and Endovascular Surgery, Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
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