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.
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.
摘要：
目的：锁骨下动脉异常（ASA）伴或不伴Kommerel憩室（KD）是一种罕见的主动脉弓解剖异常，可引起吞咽困难和/或危及生命的破裂。这项研究的目的是比较ASA/KD修复左和右主动脉弓患者的结果。
方法：使用血管低频疾病联盟方法，我们对2000~2020年在20家机构接受ASA/KD手术治疗的≥18岁患者进行了回顾性回顾.
结果：288名ASA伴或不伴KD的患者被确定；222名左心耳，66RAALAA的平均修复年龄较小54岁与58年（p=0.06）。由于症状，RAA患者更有可能接受修复(72.7%vs.55.9%,p=0.01),更有可能出现吞咽困难(57.6%vs.39.1%,p<0.01)。混合开放/血管内途径是两组中最常见的修复类型。术中并发症的发生率，30天内死亡,回到手术室,症状缓解和内漏没有显着差异。对于有症状状态的患者随访数据，在LAA，61.7%的人完全缓解，34.0%部分缓解，4.3%无变化。在RAA,60.7%的人完全缓解，34.4%部分缓解，4.9%无变化。
结论：在ASA/KD患者中，RAA患者不如LAA常见，更常见的是吞咽困难，有症状作为干预的指征，并在年轻时接受治疗。打开,血管内和混合修复方法似乎同样有效，不管拱的侧向性。
方法：使用血管低频疾病联盟方法，我们对2000~2020年在20家机构接受ASA/KD手术治疗的≥18岁患者进行了回顾性回顾.
结果：288名ASA伴或不伴KD的患者被确定；222名左心耳，66RAALAA的平均修复年龄较小54岁与58年（p=0.06）。由于症状，RAA患者更有可能接受修复(72.7%vs.55.9%,p=0.01),更有可能出现吞咽困难(57.6%vs.39.1%,p<0.01)。混合开放/血管内途径是两组中最常见的修复类型。术中并发症的发生率，30天内死亡,回到手术室,症状缓解和内漏没有显着差异。对于有症状状态的患者随访数据，在LAA，61.7%的人完全缓解，34.0%部分缓解，4.3%无变化。在RAA,60.7%的人完全缓解，34.4%部分缓解，4.9%无变化。
结论：在ASA/KD患者中，RAA患者不如LAA常见，更常见的是吞咽困难，有症状作为干预的指征，并在年轻时接受治疗。打开,血管内和混合修复方法似乎同样有效，不管拱的侧向性。
