Transcript View PowerPoint Slides

Hybrid Repair of Kommerell’s
Diverticulum
Jahanzaib Idrees MD, Suresh Keshavamurthy MD,
Sreekumar Subramanian MD, Daniel G. Clair MD,
Lars G. Svensson MD, Eric E. Roselli MD
Heart and Vascular Institute
Kommerrel’s Diverticulum
Kommerrel’s Diverticulum
• Frequently co-exists with
aberrant subclavian artery
& right sided aortic arch
Ligamentum
Arteriosum
Completing
Vascular ring
Right sided
Aortic Arch
Objectives
• To describe hybrid repair techniques
• To evaluate clinical outcomes
Patients
August 2005 to October 2010
Mean Age 57 ± 25
N=10
Elephant
Trunk
with Endo
completion
N=4
Frozen
Elephant
Trunk
N=3
TEVAR with
Cervical
Debranching
N=3
Elephant Trunk With Endo Completion
N=4
Stage I
Stage I I
Frozen Elephant Trunk
N=3
Stentgraft delivered antegrade;
sutured proximally
Ligamentum
divided
Posterior view; subclavian coiled
+ Ascending Subclavian
Bypass
TEVAR with Cervical Debranching
N=3
Right Carotid
subclavian bypass
Left Carotid
subclavian bypass
Stent Graft
Subclavian Revascularization
Revascularization
C-S Bypass
Asc-S Bypass
Unilateral (N=6)
4
2
Bilateral (N=4)
3
1
Timing
N
Preoperative
4
Intraoperative
3
Postoperative
3
Results
• No Mortality
• 1 Stroke
Post TEVAR, mild dysarthria and unilateral
leg weakness
• 2 Type II endoleaks
1 requiring Subclavian embolization
• No paraplegia
• No Respiratory failure
• No Renal failure
• No Reoperation for bleeding
Conclusions
Hybrid repair of Kommerell’s diverticulum is
safe and effective.
Type of intervention is based on patient’s
anatomy and co-morbid conditions.