Author + information
- Benjamin William Hale,
- Jimmy Lu,
- Jennifer Romano,
- Edward J. Richer,
- Ray Lowery and
- Mark Norris
Background: A Kommerell Diverticulum (KD) is the dilated proximal portion of an aberrant subclavian artery as a consequence of abnormal embryonic vascular development. Concern has arisen for aneurysmal KD dilation, dissection and rupture, with a trend toward invasive prophylactic intervention. This study aimed to characterize size and outcomes of KD.
Methods: All patients with KD detected on computed tomography or magnetic resonance from 2000-2016 at our center were retrospectively identified. Symptoms and complications were ascertained from the medical record. The maximum short axis diameter (KDmax) was measured and indexed to aortic diameter at the diaphragm (DAo) and proximal subclavian artery diameter (SA).
Results: We identified 115 patients with KD age 0-86.7 years (median 34), including 64 over age 20. Arch side was right in 73 (63%), and left in 42 (37%). An incidental diagnosis of KD was made in 52 (45%), including 44 (69%) over age 20. There were 62 (54%) asymptomatic patients, including 50 (78%) over age 20. The mean KDmax/DAo was 0.97 ± 0.2, and KDmax/SA was 2.26 ± 0.7. Linear regression showed there was an association with KDmax and age (p< 0.001), but not when indexed to DAo or SA (p = 0.12 and 0.48, respectively). Aortic dissection was seen in 4 patients aged 58.7-80.0 years (3.5% of all patients), with only 2 involving the KD (1.7%). One patient had a focal dissection of a right SA distal to the KD. Only 1 patient had rupture of a type A dissection that did not extend to the KD.
Conclusions: The majority of patients with KD were found incidentally and were asymptomatic, particularly when diagnosed in adulthood. Growth of KD appears to be proportional to growth of other vessels, arguing against progressive isolated KD dilation with age. The rates of dissection and rupture were lower than reported in previous case series, and only occurred later in life. Longitudinal study is needed to guide the application of invasive intervention in the face of surgical comorbidities for unclear vascular risk.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Vascular Medicine: Emerging Concepts in Clinical Vascular Diseases
Abstract Category: 40. Vascular Medicine: Non Coronary Arterial Disease
Presentation Number: 1254-351
- 2017 American College of Cardiology Foundation