Aberrant subclavian artery and Kommerell aneurysm: surgical treatment with a standard approach.

OBJECTIVE: We report our experience with a standard surgical technique for treatment of aneurysms associated with Kommerell diverticulum and aberrant subclavian artery.

METHODS: During a 10-year interval, 10 patients with aneurysms of Kommerell diverticulum and aberrant subclavian artery (8 right, 2 left) underwent surgical repair. All 10 patients had aneurysmal degeneration of the adjacent descending thoracic aorta and 7 had aneurysms of the nonaberrant subclavian artery that required treatment. Four of the patients with large Kommerell aneurysms underwent preliminary carotid-to-aberrant subclavian artery bypass and ligation of the subclavian artery proximal to the origin of the vertebral artery. All patients had graft replacement of the subclavian artery and descending thoracic aneurysms through a left thoracotomy using hypothermic cardiopulmonary bypass and circulatory arrest. Continuity of the aberrant subclavian artery was preserved in the 6 patients without prior carotid-to-subclavian artery bypass.

RESULTS: There were no in-hospital deaths. One patient required reoperation for bleeding, 1 patient developed recurrent laryngeal nerve injury, and 1 patient with delirium had evidence for infarction in the caudate nucleus but recovered completely. There were 4 late deaths from 1.5 to 44 months postoperatively. The remaining 6 patients are well from 8 to 131 months after operation.

CONCLUSIONS: Aneurysms of Kommerell diverticulum and coexisting aneurysms of the adjacent descending thoracic aorta and nonaberrant subclavian artery can be repaired safely with the technique we have utilized.