Skip to main content

Advertisement

SpringerLink
Log in

Kommerell’s diverticulum in the current era: a comprehensive review

  • Current Topics Review Article
  • Published:
General Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Kommerell’s diverticulum is a developmental error with a remnant of fourth dorsal aortic arch, named after Dr. Kommerell, a radiologist, who made the first diagnosis in a living individual. The diverticulum can occur in both the left and right aortic arch, from which an aberrant subclavian artery rises to the contralateral side. Pediatric patients often present with airway symptoms whereas dysphagia and chest discomfort are more common in the adult patients. Computed tomography or magnetic resonance imaging can provide details of the diverticulum, associated arch anomalies, and its relationship with surrounding organs. Recent histological studies indicated the presence of cystic medial necrosis in the diverticulum wall, which would explain the reported high rates of aortic dissection and rupture associated with the diverticulum. Accumulated knowledge on this entity and the recent advancement of imaging techniques, surgical/endovascular strategies, and perioperative management, have led to more aggressive intervention to the diverticulum in the early phase. While still under debate it is generally accepted to consider surgical intervention when the diameter of the diverticulum orifice exceeds over 30 mm, and/or the diameter of the descending aorta adjacent to the diverticulum exceeds over 50 mm. Treatment options include open surgical repair, hybrid endovascular repair, and total endovascular repair. The selection of treatment strategy for Kommerell’s diverticulum should be based on the anatomy, comorbidities of the patient, and surgical expertise available. The summaries of open and endovascular repairs of over 210 cases from literature search from 2004 to 2014 are also provided in this review.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Kommerell B. Verlagerung des ösophagus durch eine abnorm verlaufende arteria subclavia dextra (arteria lusoria). Fortschr Geb Roentgenstrahlen. 1936;54:590–5.

    Google Scholar 

  2. Bayford D. An account of a singular case of obstructed deglutition. Medical Society of London; 1787.

  3. Asherson N. David bayford. His syndrome and sign of dysphagia lusoria. Ann R Coll Surg Engl. 1979;61(1):63–7.

    PubMed Central  CAS  PubMed  Google Scholar 

  4. Arkin A. Totale persistenz des rechten aortenbogens im röntgenbild. Wien Arch f inn med. 1926;12:385.

    Google Scholar 

  5. Molz G, Burri B. Aberrant subclavian artery (arteria lusoria): Sex differences in the prevalence of various forms of the malformation. Evaluation of 1378 observations. Virchows Arch A Pathol Anat Histol. 1978;380(4):303–15.

    CAS  PubMed  Google Scholar 

  6. Backer CL, Russell HM, Wurlitzer KC, Rastatter JC, Rigsby CK. Primary resection of kommerell diverticulum and left subclavian artery transfer. Ann Thorac Surg. 2012;94(5):1612–7.

    PubMed  Google Scholar 

  7. Edwards JE. Anomalies of the derivatives of the aortic arch system. Med Clin North Am. 1948;32:925–49.

    CAS  PubMed  Google Scholar 

  8. Lescalie F, Peret M, Reigner B, Cronier P, Pillet J. Reconstruction of an abnormal artery observed in an 11 mm embryo: considerations on the embryologic origin of the subclavian artery. Surg Radiol Anat. 1992;14(1):71–9.

    CAS  PubMed  Google Scholar 

  9. Congdon ED. Transformation of the aortic-arch system during the development of the human embryo. Contrib Embryol. 1922;14(68):49–110.

    Google Scholar 

  10. Padget DH. Designation of the embryonic intersegmental arteries in reference to the vertebral artery and subclavian stem. Anat Rec. 1954;119(3):349–56.

    CAS  PubMed  Google Scholar 

  11. Myers PO, Fasel JH, Kalangos A, Gailloud P. Arteria lusoria: developmental anatomy, clinical, radiological and surgical aspects. Ann Cardiol Angeiol. 2010;59(3):147–54.

    CAS  Google Scholar 

  12. Corone P, Vernant P. Anomalies des arcs aortiques. Encycl Med Chir, Coeur et vaisseaux Elsevier, Paris. 1970;11:40–50.

    Google Scholar 

  13. Brown DL, Chapman WC, Edwards WH, Coltharp WH, Stoney WS. Dysphagia lusoria: aberrant right subclavian artery with a kommerell’s diverticulum. Am Surg. 1993;59(9):582–6.

    CAS  PubMed  Google Scholar 

  14. Generali T, Varrica A, Frigiola A. Right-sided aortic arch with kommerell’s diverticulum causing tracheal stenosis. Asian Cardiovasc Thorac Ann. 2013;21(2):243–4.

    PubMed  Google Scholar 

  15. Lesko M, Zacek P, Belobradek Z, Raupach J, Vojacek J. One-step supraclavicular approach to the treatment of dysphagia lusoria. J Card Surg. 2014;29(4):519–22.

    PubMed  Google Scholar 

  16. Austin EH, Wolfe WG. Aneurysm of aberrant subclavian artery with a review of the literature. J Vasc Surg. 1985;2(4):571–7.

    CAS  PubMed  Google Scholar 

  17. Han MT, Hall DG, Manche A, Rittenhouse EA. Double aortic arch causing tracheoesophageal compression. Am J Surg. 1993;165(5):628–31.

    CAS  PubMed  Google Scholar 

  18. Kleine P, Balci M, Moritz A. Primary complete repair of partial double aortic arch and kommerell diverticulum. Ann Thorac Surg. 2011;91(2):627–9.

    PubMed  Google Scholar 

  19. Mossad E, Farid I, Youssef G, Ando M. Diverticulum of kommerell: a review of a series and a report of a case with tracheal deviation compromising single lung ventilation. Anesth Analg. 2002;94(6):1462–4 (Table of contents).

    PubMed  Google Scholar 

  20. Saeed G, Neuzner J, Gradaus R. Double aortic arch and kommerell’s diverticulum. Asian Cardiovasc Thorac Ann. 2014;22(7):882–3.

    PubMed  Google Scholar 

  21. Avisse C, Marcus C, Delattre JF, et al. Right nonrecurrent inferior laryngeal nerve and arteria lusoria: the diagnostic and therapeutic implications of an anatomic anomaly. Review of 17 cases. Surg Radiol Anat. 1998;20(3):227–32.

    CAS  PubMed  Google Scholar 

  22. Salomonowitz E, Edwards JE, Hunter DW, et al. The three types of aortic diverticula. AJR Am J Roentgenol. 1984;142(4):673–9.

    CAS  PubMed  Google Scholar 

  23. Grollman JH Jr, Harris CH, Hamilton LC. Congenital diverticula of the aortic arch. N Engl J Med. 1967;276(21):1178–82.

    PubMed  Google Scholar 

  24. van Son JA, Konstantinov IE. Burckhard f. Kommerell and kommerell’s diverticulum. Tex Heart Inst J. 2002;29(2):109–12.

    PubMed Central  PubMed  Google Scholar 

  25. Kim KM, Cambria RP, Isselbacher EM et al. Contemporary surgical approaches and outcomes in adults with kommerell diverticulum. Ann Thorac Surg. 2014;98(4):1347–54.

    PubMed  Google Scholar 

  26. Velasquez G, Nath PH, Castaneda-Zuniga WR, Amplatz K, Formanek A. Aberrant left subclavian artery in tetralogy of fallot. Am J Cardiol. 1980;45(4):811–8.

    CAS  PubMed  Google Scholar 

  27. Nakajima Y, Nishibatake M, Ikeda K, Momma K, Takao A, Terai M. Abnormal development of fourth aortic arch derivatives in the pathogenesis of tetralogy of fallot. Pediatr Cardiol. 1990;11(2):69–71.

    CAS  PubMed  Google Scholar 

  28. Stone WM, Ricotta JJ 2nd, Fowl RJ, Garg N, Bower TC, Money SR. Contemporary management of aberrant right subclavian arteries. Ann Vasc Surg. 2011;25(4):508–14.

    PubMed  Google Scholar 

  29. Hastreiter AR, D’Cruz IA, Cantez T, Namin EP, Licata R. Right-sided aorta. I. Occurrence of right aortic arch in various types of congenital heart disease. Ii. Right aortic arch, right descending aorta, and associated anomalies. Br Heart J. 1966;28(6):722–39.

    PubMed Central  CAS  PubMed  Google Scholar 

  30. Freed K, Low VH. The aberrant subclavian artery. AJR Am J Roentgenol. 1997;168(2):481–4.

    CAS  PubMed  Google Scholar 

  31. Tsukube T, Ataka K, Sakata M, Wakita N, Okita Y. Surgical treatment of an aneurysm in the right aortic arch with aberrant left subclavian artery. Ann Thorac Surg. 2001;71(5):1710–1.

    CAS  PubMed  Google Scholar 

  32. Holzapfel G. Ungewöhnlicher ursprung und verlauf der arteria subclavia dextra. Anatomische Hefte 1899;12(3):369-523 ( 0177-5154).

  33. Woods RK, Sharp RJ, Holcomb GW 3rd, et al. Vascular anomalies and tracheoesophageal compression: A single institution’s 25-year experience. Ann Thorac Surg. 2001;72(2):434–8 (Discussion 438–439).

    CAS  PubMed  Google Scholar 

  34. Backer CL, Mavroudis C, Rigsby CK, Holinger LD. Trends in vascular ring surgery. J Thorac Cardiovasc Surg. 2005;129(6):1339–47.

    PubMed  Google Scholar 

  35. Gomes MM, Bernatz PE, Forth RJ. Arteriosclerotic aneurysm of an aberrant right subclavian artery. Dis Chest. 1968;54(6):549–52.

    CAS  PubMed  Google Scholar 

  36. Brown K, Batra P. Mr imaging of aneurysm of an aberrant right subclavian artery. J Comput Assist Tomogr. 1987;11(6):1071–3.

    CAS  PubMed  Google Scholar 

  37. Felson B. Ruptured anomalous right subclavian artery: aneurysm or diverticulum? Semin Roentgenol. 1989;24(2):121–6.

    CAS  PubMed  Google Scholar 

  38. Atay Y, Engin C, Posacioglu H, et al. Surgical approaches to the aberrant right subclavian artery. Tex Heart Inst J. 2006;33(4):477–81.

    PubMed Central  PubMed  Google Scholar 

  39. Beabout JW, Stewart JR, Kincaid OW. Aberrant right subclavian artery: dispute of commonly accepted concepts. Am J Roentgenol Radium Ther Nucl Med. 1964;92:855–64.

    CAS  PubMed  Google Scholar 

  40. Aoyagi S, Akashi H, Tayama K, Fujino T. Aneurysm of aberrant right subclavian [corrected] artery arising from diverticulum of kommerell. Report of a case with tracheal compression. Eur J Cardiothorac Surg. 1997;12(1):138–40.

    CAS  PubMed  Google Scholar 

  41. Davidian M, Kee ST, Kato N, et al. Aneurysm of an aberrant right subclavian artery: treatment with ptfe covered stentgraft. J Vasc Surg. 1998;28(2):335–9.

    CAS  PubMed  Google Scholar 

  42. Cina CS, Arena GO, Bruin G, Clase CM. Kommerell’s diverticulum and aneurysmal right-sided aortic arch: a case report and review of the literature. J Vasc Surg. 2000;32(6):1208–14.

    CAS  PubMed  Google Scholar 

  43. Caus T, Gaubert JY, Monties JR, et al. Right-sided aortic arch: surgical treatment of an aneurysm arising from a kommerell’s diverticulum and extending to the descending thoracic aorta with an aberrant left subclavian artery. Cardiovasc Surg. 1994;2(1):110–3.

    CAS  PubMed  Google Scholar 

  44. Ota T, Okada K, Takanashi S, Yamamoto S, Okita Y. Surgical treatment for kommerell’s diverticulum. J Thorac Cardiovasc Surg. 2006;131(3):574–8.

    PubMed  Google Scholar 

  45. Kouchoukos NT, Masetti P. Aberrant subclavian artery and kommerell aneurysm: surgical treatment with a standard approach. J Thorac Cardiovasc Surg. 2007;133(4):888–92.

    PubMed  Google Scholar 

  46. Cina CS, Althani H, Pasenau J, Abouzahr L. Kommerell’s diverticulum and right-sided aortic arch: a cohort study and review of the literature. J Vasc Surg. 2004;39(1):131–9.

    CAS  PubMed  Google Scholar 

  47. Idrees J, Keshavamurthy S, Subramanian S, Clair DG, Svensson LG, Roselli EE. Hybrid repair of kommerell diverticulum. J Thorac Cardiovasc Surg. 2014;147(3):973–6.

    PubMed  Google Scholar 

  48. Tsukui H, Aomi S, Yamazaki K. Surgical strategy for kommerell’s diverticulum: total arch replacement. J Thorac Cardiovasc Surg. 2014;148(4):1423–7.

    PubMed  Google Scholar 

  49. Ishikawa N, Oi M, Maruta K, Iizuka H, Kawaura H. Surgical treatment for right aortic arch with kommerell’s diverticulum. Asian Cardiovasc Thorac Ann. 2013;21(6):724–6.

    PubMed  Google Scholar 

  50. Abuchaim DC, Burger M, Berwanger SA, Faraco DL. Vascular ring related to kommerell diverticula: case report. Rev Bras Cir Cardiovasc. 2007;22(3):352–4.

    PubMed  Google Scholar 

  51. Grillo HC, Wright CD. Tracheal compression with “hairpin” right aortic arch: management by aortic division and aortopexy by right thoracotomy guided by intraoperative bronchoscopy. Ann Thorac Surg. 2007;83(3):1152–7.

    PubMed  Google Scholar 

  52. Munakata M, Itaya H, Fukui K, Ono Y. One-stage repair for aortic regurgitation and kommerell diverticulum with aneurysmal right aortic arch. J Thorac Cardiovasc Surgery. 2007;133(3):798–9.

    Google Scholar 

  53. Alvarez JR, Quiroga SJ, Nazar AB, Comendador MJ, Carro GJ. Aberrant right subclavian artery and calcified aneurysm of kommerell’s diverticulum: an alternative approach. J Cardiothorac Surg. 2008;3:43.

    PubMed Central  PubMed  Google Scholar 

  54. Hata H, Shibukawa T, Satoh H. Surgical repair of aberrant subclavian artery through clamshell approach. Ann Thorac Surg. 2012;94(4):1362–4.

    PubMed  Google Scholar 

  55. Kim JB, Yang DH, Kang JW. Right aortic arch and an aberrant left subclavian artery arising from a kommerell diverticulum complicated by acute aortic dissection. J Thorac Cardiovasc Surg. 2012;144(4):978–9.

    PubMed  Google Scholar 

  56. Shinkawa T, Greenberg SB, Jaquiss RD, Imamura M. Primary translocation of aberrant left subclavian artery for children with symptomatic vascular ring. Ann Thorac Surg. 2012;93(4):1262–5.

    PubMed  Google Scholar 

  57. Scaglione M, Pinto A, Di Pietto F, Meucci E, Lassandro F. Traumatic avulsion of an aberrant right subclavian artery associated with a diverticulum of kommerell in a patient with bicarotid trunk: multidetector ct diagnosis. J Trauma. 2009;67(4):E115–7.

    PubMed  Google Scholar 

  58. Kir M, Saylam GS, Karadas U, et al. Vascular rings: presentation, imaging strategies, treatment, and outcome. Pediatr Cardiol. 2012;33(4):607–17.

    PubMed  Google Scholar 

  59. Panduranga P, Al-Delamie T, Ratnam L, Al-Mukhaini M, Zachariah S. Repair of kommerell’s diverticulum with aberrant left subclavian artery in an elderly patient with right aortic arch and dysphagia lusoria. J Card Surg. 2011;26(6):637–40.

    PubMed  Google Scholar 

  60. Taif S. Al Kalbani J A case of acute traumatic aortic injury of a right-sided aortic arch with rupture of an aberrant left subclavian artery. J Radiol Case Rep. 2013;7(12):1–9.

    PubMed Central  PubMed  Google Scholar 

  61. Inami T, Seino Y, Mizuno K. Unique case of giant kommerell diverticulum with aberrant left subclavian artery arising from the left aortic arch associated with situs inversus. Int J Cardiol. 2013;163(3):e47–8.

    PubMed  Google Scholar 

  62. Reyes KG, Gill IS, Temes T, Griffin NC. Aortoesophageal fistula associated with a kommerell diverticulum and right-sided aortic arch. J Thorac Cardiovasc Surg. 2008;136(4):1091–3.

    PubMed  Google Scholar 

  63. Suarez AE, Slivka R. Acute superior vena cava syndrome after rupture of kommerell’s diverticulum: a case report. Ann Emerg Med. 2013;61(3):348–50.

    PubMed  Google Scholar 

  64. Bhandary SP, Papadimos TJ, Svensson LG, Sale S. Anesthetic management of the resection of a kommerell’s diverticulum. J Cardiothorac Vasc Anesth. 2015;29(1):142–5.

    PubMed  Google Scholar 

  65. Hosoba S, Suzuki T, Asai T, et al. Surgical repair of kommerell’s diverticulum and an aberrant subclavian artery. Surg Today. 2014;44(2):247–51.

    PubMed  Google Scholar 

  66. Hori D, Tanaka M, Yamaguchi A, Adachi H. Type a aortic dissection, right-sided aortic arch, and thoracic aortic aneurysm. Asian Cardiovasc Thorac Ann. 2009;17(6):640–2.

    PubMed  Google Scholar 

  67. Keeling WB, Kerendi F, Chen EP. Total aortic arch replacement for the treatment of kommerell’s diverticulum in a jehovah’s witness. J Card Surg. 2010;25(3):333–5.

    PubMed  Google Scholar 

  68. Kim SY, Lee YS, Bae KR, Lee JB, Lee S, Kwon OC. A case of type b dissecting aneurysm involving right sided aorta with kommerell’s diverticulum. Korean J Intern Med. 2010;25(3):327–30.

    PubMed Central  PubMed  Google Scholar 

  69. Obitsu Y, Koizumi N, Iwahashi T, Saiki N, Shigematsu H. Surgical repair for aortic dissection accompanying a right-sided aortic arch. J Cardiothorac Surg. 2010;5:35.

    PubMed Central  PubMed  Google Scholar 

  70. Pac FA, Okten S, Ece I. Left aortic arch and right descending aorta with kommerell’s diverticulum. Pediatr Cardiol. 2010;31(6):933–4.

    PubMed  Google Scholar 

  71. Reece TB, Wallen TJ, Jagasia DH, Bavaria JE, Szeto WY. Open thoracic aortic repair for dysphagia in patients with kommerell’s diverticulum and right-sided aortic arch with aberrant left subclavian artery. J Card Surg. 2010;25(1):62–4.

    PubMed  Google Scholar 

  72. Cox DA, Quinn RD, Moran AM. Two cases of a double aortic arch with left arch atresia subtype 2 and kommerell’s diverticulum. Cardiol Young. 2011;21(2):220–1.

    PubMed  Google Scholar 

  73. Kasnar-Samprec J, Schreiber C, Horer J, et al. Primary resection of kommerell’s diverticulum in a 37-year-old patient. Thorac Cardiovasc Surg. 2011;59(5):307–8.

    CAS  PubMed  Google Scholar 

  74. Lee CY, Moraca RJ, Benckart DH, Bailey SH, Magovern GJ Jr, Muluk S. Thoracic endovascular aortic repair of an aberrant right subclavian artery: technique and long-term outcome. J Card Surg. 2010;25(4):390–3.

    PubMed  Google Scholar 

  75. Akita M, Urashima K. A remnant left aortic arch and a right aortic arch as well as kommerell’s diverticulum with an aberrant left subclavian artery. Interact Cardiovasc Thorac Surg. 2011;12(1):70–1.

    PubMed  Google Scholar 

  76. Wolford HY, Surowiec SM, Hsu JH, et al. Stacked proximal aortic cuffs: an “off-the-shelf” solution for treating focal thoracic aortic pathology. J Endovasc Ther. 2005;12(5):574–8.

    PubMed  Google Scholar 

  77. Odero A, Bozzani A, Pirrelli S. Endovascular treatment of acute type b dissection and kommerell’s diverticulum. Ann Thorac Surg. 2007;84(5):1736–8.

    PubMed  Google Scholar 

  78. Naoum JJ, Parenti JL, LeMaire SA, Coselli JS. Endovascular repair of a right-sided descending thoracic aortic aneurysm with a right-sided aortic arch and aberrant left subclavian artery. Ann Thorac Surg. 2008;85(3):1074–6.

    PubMed  Google Scholar 

  79. Dainese L, Spirito R, Barili F, et al. Right aortic arch related to kommerell diverticulum and internal carotid artery agenesis. Circ Cardiovasc Imaging. 2009;2(2):e6–7.

    PubMed  Google Scholar 

  80. Frigatti P, Grego F, Deriu GP, Lepidi S. Hybrid endovascular treatment of aneurysm degeneration in a rare right-aortic arch anomaly with kommerell diverticulum. J Vasc Surg. 2009;50(4):903–6.

    PubMed  Google Scholar 

  81. Midorikawa H, Kannno M, Ishikawa K, Takano T, Ono T, Morishima S. Endovascular repair of a kommerell’s diverticulum and aneurysmal right-sided aortic arch: a case report. Ann Vasc Dis. 2009;2(1):54–7.

    PubMed Central  PubMed  Google Scholar 

  82. Riesenman PJ, Campbell CL, Farber MA. Endovascular repair of a kommerell’s diverticulum in a patient with a left-sided aortic arch and right-sided descending thoracic aorta. J Vasc Surg. 2009;49(6):1577–9.

    PubMed  Google Scholar 

  83. Bosma J, van Swijndregt AD, Vahl AC. Hybrid treatment of a ruptured diverticulum of kommerell. J Endovasc Ther. 2010;17(6):762–6.

    PubMed  Google Scholar 

  84. Murzi M, Mariani M, Karimov JH, Gilmanov D, Berti S, Glauber M. Hybrid repair of a kommerell’s diverticulum aneurysm. J Card Surg. 2010;25(1):67–9.

    PubMed  Google Scholar 

  85. Kawajiri H, Shimizu H, Yoshitake A, Yozu R. Hybrid repair of a kommerell diverticulum associated with a right aortic arch and a left descending aorta. J Vasc Surg. 2012;56(6):1727–30.

    PubMed  Google Scholar 

  86. Stanley GA, Arko FR 3rd, Foteh MI, Jessen ME, DiMaio JM. Hybrid endovascular treatment of an anomalous right subclavian artery dissection in a patient with marfan syndrome. Ann Thorac Surg. 2012;94(2):639–41.

    PubMed  Google Scholar 

  87. Yamashiro S, Nagano T, Kuniyoshi Y, Kise Y, Maeda T, Arakaki R. Endovascular repair of intrathoracic ruptured kommerell’s diverticulum. Asian Cardiovasc Thorac Ann. 2012;20(5):587–90.

    PubMed  Google Scholar 

  88. Andersen ND, Barfield ME, Hanna JM, et al. Intrathoracic subclavian artery aneurysm repair in the thoracic endovascular aortic repair era. J Vasc Surg. 2013;57(4):915–25.

    PubMed  Google Scholar 

  89. Gafoor S, Stelter W, Bertog S, Sievert H. Fully percutaneous treatment of an aberrant right subclavian artery and thoracic aortic aneurysm. Vascular medicine. 2013;18(3):139–44.

    PubMed  Google Scholar 

  90. Knepper J, Criado E. Surgical treatment of kommerell’s diverticulum and other saccular arch aneurysms. J Vasc Surg. 2013;57(4):951–4.

    PubMed  Google Scholar 

  91. Silveira PG, Franklin RN, Cunha JR, Neves TT, Nascimento GG, Bortoluzzi CT. Total endovascular repair of aberrant left subclavian artery with kommerell’s diverticulum using a customized branched device. J Vasc Surg. 2013;57(4):1123–5.

    PubMed  Google Scholar 

  92. Wong RH, Chow SC, Lok JK, et al. Hybrid treatment for ruptured diverticulum of kommerell: a minimally invasive option. Ann Thorac Surgery. 2013;95(4):e95–6.

    Google Scholar 

  93. Guo Y, Yang B, Cai H, Jin H. Hybrid repair of penetrating aortic ulcer associated with right aortic arch and aberrant left innominate artery arising from aneurysmal kommerell’s diverticulum with simultaneous repair of bilateral common iliac artery aneurysms. Ann Vasc Surg. 2014;28(2):490.e5–8.

    Google Scholar 

  94. Kawajiri H, Oka K, Kanda K, Yaku H. Two-stage hybrid repair for a kommerell diverticulum in a right-sided aortic arch associated with multivessel coronary disease and atrial septal defect. J Thorac Cardiovasc Surg. 2014;147(1):532–4.

    PubMed  Google Scholar 

  95. Monaco M, Lillo S, La Marca Giordano A, Contaldo A, Schiavone V. Endovascular repair of a right-sided thoracic aortic aneurysm with kommerell diverticulum and aberrant left subclavian artery. Annals of vascular surgery. 2014;28(5):1323 e1321–5.

    Google Scholar 

  96. Vucemilo I, Harlock JA, Qadura M, Guirgis M, Gowing RN, Tittley JG. Hybrid repair of symptomatic aberrant right subclavian artery and kommerell’s diverticulum. Ann Vasc Surg. 2014;28(2):411–20.

    PubMed  Google Scholar 

  97. Motoki M, Hattori K, Kato Y, et al. Endovascular repair of ruptured aberrant left subclavian artery with right aortic arch. Ann Thorac Surg. 2013;95(2):699–701.

    PubMed  Google Scholar 

  98. Kobayashi N, Takebayashi T, Saito S, Terashita T, Shimokawa T, Matsuda S. Coincidence of a right retroaortic circumflex coronary artery and a right-sided aortic arch with a retroesophageal course of the left subclavian artery (arteria lusoria). Clin Anat. 2006;19(4):354–7.

    CAS  PubMed  Google Scholar 

  99. Lee TY, Ng SH, Liang CD, Hsieh MJ, Ko SF. Dissection of kommerell’s aneurysm mimicking aortic arch dissection on echocardiography: multislice computed tomographic diagnosis. J Thorac Cardiovasc Surg. 2006;132(5):1228–30.

    PubMed  Google Scholar 

  100. Nozue T, Mori N, Michishita I. A case diagnosed as bronchial asthma revealing a diverticulum of kommerell with an aberrant right subclavian artery. Intern Med. 2006;45(10):701–2.

    PubMed  Google Scholar 

  101. Kanazawa S, Kinoshita Y, Sougawa M, Yamaguchi K, Nomura S. High-grade stenosis of the trachea caused by a kommerell’s diverticulum in a right-sided aortic arch. Intern Med. 2007;46(12):919–20.

    PubMed  Google Scholar 

  102. Panagiotou M, Filias V, Prokakis C, Koletsis E. Asymptomatic pseudo-aneurysm of the aortic arch in a patient with aberrant right subclavian artery. A complication of kommerell’s diverticulum? Interact Cardiovasc Thorac Surg. 2008;7(4):730–1.

    PubMed  Google Scholar 

  103. Barranhas AD, Indiani JM, Marchiori E, Santos AA, Rochitte CE. Atypical presentation of kommerell’s diverticulum. Arq Bras Cardiol. 2009;e88-90(6):e101–3.

    Google Scholar 

  104. Carbone I, Sedati P, Galea N, Algeri E, Passariello R. Right-sided aortic arch with kommerell’s diverticulum: 64-dcta with 3d reconstructions. BMJ case reports 2009; 2009:bcr2007087072.

  105. Klonaris C, Avgerinos ED, Katsargyris A, et al. Endovascular repair of a right-sided descending thoracic aortic aneurysm associated with a right aortic arch and a left subclavian artery arising from a kommerell’s diverticulum. Cardiovasc Intervent Radiol. 2009;32(4):758–61.

    PubMed  Google Scholar 

  106. Mouton WG, Wyss A. Kommerell’s diverticulum. Euro J Cardiothorac Surg. 2009;36(1):188.

    Google Scholar 

  107. Rousou AJ, Tetenta S, Boffa DJ. Pulmonary artery agenesis and kommerell’s diverticulum presenting with hemoptysis. Euro J Cardiothorac Surg. 2009;35(2):370–2.

    Google Scholar 

  108. Agematsu K, Ueda T, Hoshino S, Nishiya Y. Rupture of kommerell diverticulum after total arch replacement. Interact CardioVasc Thorac Surg. 2010;11(6):800–2.

    PubMed  Google Scholar 

  109. Cannavale A, Francone M, Galea N, Roggini M, Carbone I. Three-dimensional magnetic resonance imaging of kommerell diverticulum in a child with recurrent dysphagia. J Pediatr Surg. 2010;45(10):2092–3.

    PubMed  Google Scholar 

  110. Fang HY, Wu CJ. Haemomediastinum, haemopericardium and haemothorax caused by elective transradial coronary angiography in a rare kommerell’s diverticulum. Euro J Cardiothorac Surg. 2010;37(4):957.

    Google Scholar 

  111. Kawano T, Soeda M, Hata H, Hirayama A. Multidetector computed tomography images of right aortic arch and a left subclavian artery arising from a kommerell diverticulum. J Am Coll Cardiol. 2010;55(7):697.

    PubMed  Google Scholar 

  112. Nagashima M, Shikata F, Higaki T, Kawachi K. Cervical aortic arch and kommerell’s diverticulum associated with the anomalous subaortic left brachiocephalic vein in a patient with chromosome 22q11.2 deletion. Interact CardioVasc Thorac Surg. 2010;11(2):202–3.

    PubMed  Google Scholar 

  113. Nakahira A, Hirai H, Sasaki Y, Suehiro S. Agenesis of the left carotid artery in the right aortic arch with kommerell diverticulum. J Thorac Cardiovasc Surg. 2010;140(1):e5–7.

    PubMed  Google Scholar 

  114. Wu JY, Chen HY, Shu CC, Yu CJ. Kommerell diverticulum, right-sided aorta, and left aberrant subclavian artery in a patient with dysphagia. J Thorac Cardiovasc Surg. 2010;139(5):e97–8.

    PubMed  Google Scholar 

  115. Anagnostakou V, Nenekidis I, Zisis C, Dedeilias P. Huge kommerell’s diverticulum associated with type-b aortic dissection. Euro J Cardiothorac Surg. 2011;40(3):771.

    Google Scholar 

  116. Luty C, Laroia S, Burr M. Spontaneous kommerell diverticulum dissection. J Vasc Interv Radiol. 2012;23(11):1443.

    PubMed  Google Scholar 

  117. Margolis J, Bilfinger T, Labropoulos N. A right-sided aortic arch and aberrant left subclavian artery with proximal segment hypoplasia. Interact CardioVasc Thorac Surg. 2012;14(3):370–1.

    PubMed Central  PubMed  Google Scholar 

  118. Shiga Y, Miura S, Hitaka Y, Saku K. Right aortic arch with kommerell’s diverticulum using 64-mdct. Intern Med. 2012;51(11):1437–8.

    PubMed  Google Scholar 

  119. Demirkol S, Balta S, Bozlar U, Sari S, Unlu M, Arslan Z. Kommerell diverticulum associated with aberrant left subclavian artery and right-sided aortic arch. Euro Heart J Cardiovasc Imaging. 2013;14(8):764.

    Google Scholar 

  120. Marinho J, Pires A, Sousa G, Castela E. Right subclavian artery aneurysm in an adolescent with a bicuspid aortic valve. Pediatr Cardiol. 2013;34(8):1952–4.

    CAS  PubMed  Google Scholar 

  121. Strachinaru M, Damry N, Nazeri A, Jousten I, Costescu I. Right-sided gothic aortic arch and kommerell diverticulum. Euro Heart J Cardiovasc Imaging. 2013;14(9):864.

    Google Scholar 

  122. Lee CH, Son JW, Park JS. Comprehensive three-dimensional analysis of right-sided aortic arch with multiple vascular anomalies. BMC Cardiovasc Disord. 2014;14:104.

    PubMed Central  PubMed  Google Scholar 

  123. Bodine JA, D’Souza VJ, Formanek AG. An unusual type of dissecting thoracic aneurysm in association with right aortic arch. VASA Zeitschrift fur Gefasskrankheiten. 1982;11(3):223–8.

    CAS  PubMed  Google Scholar 

  124. Fraisse A, Ovaert C, Luciano D, Mitchell J, Kreitmann B. Kommerell diverticulum should be removed when operating symptomatic children with aberrant right subclavian artery (vascular ring). J Am College Cardiol 2013;61(10_S).

  125. Alper F, Akgun M, Kantarci M, et al. Demonstration of vascular abnormalities compressing esophagus by mdct: special focus on dysphagia lusoria. Eur J Radiol. 2006;59(1):82–7.

    PubMed  Google Scholar 

  126. Malik TH, Bruce IA, Kaushik V, Willatt DJ, Wright NB, Rothera MP. The role of magnetic resonance imaging in the assessment of suspected extrinsic tracheobronchial compression due to vascular anomalies. Arch Dis Child. 2006;91(1):52–5.

    PubMed Central  CAS  PubMed  Google Scholar 

  127. Apley J. Congenital anomalies of the aortic arch and its branches. Proc R Soc Med. 1949;42(11):918–22.

    PubMed Central  CAS  PubMed  Google Scholar 

  128. Mahoney EB, Manning JA. Congenital abnormalities of the aortic arch. Surgery. 1964;55:1–14.

    CAS  PubMed  Google Scholar 

  129. Janssen M, Breburda CS, van Geuns RJ, et al. Images in cardiovascular medicine. Aberrant right subclavian artery mimics aortic dissection. Circulation. 2000;101(4):459–60.

    CAS  PubMed  Google Scholar 

  130. Julsrud PR, Ehman RL. Magnetic resonance imaging of vascular rings. Mayo Clin Proc. 1986;61(3):181–5.

    CAS  PubMed  Google Scholar 

  131. Sahn DJ, Valdes-Cruz LM, Ovitt TW, et al. Two dimensional echocardiography and intravenous digital video subtraction angiography for diagnosis and evaluation of double aortic arch. Am J Cardiol. 1982;50(2):342–6.

    CAS  PubMed  Google Scholar 

  132. Yusuf TE, Levy MJ, Wiersema MJ, et al. Utility of endoscopic ultrasound in the diagnosis of aberrant right subclavian artery. J Gastroenterol Hepatol. 2007;22(11):1717–21.

    PubMed  Google Scholar 

  133. Hernandez RJ. Magnetic resonance imaging of mediastinal vessels. Magn Reson Imaging Clin N Am. 2002;10(2):237–51.

    PubMed  Google Scholar 

  134. Lee EY, Siegel MJ, Hildebolt CF, Gutierrez FR, Bhalla S, Fallah JH. Mdct evaluation of thoracic aortic anomalies in pediatric patients and young adults: comparison of axial, multiplanar, and 3d images. AJR Am J Roentgenol. 2004;182(3):777–84.

    PubMed  Google Scholar 

  135. Kai M, Okabayashi H, Soga Y, et al. Total arch replacement through a midsternotomy for a right-sided aortic arch aneurysm with an aberrant left subclavian artery. J Thorac Cardiovasc Surg. 2006;132(6):1473–5.

    PubMed  Google Scholar 

  136. Benumof JL, Partridge BL, Salvatierra C, Keating J. Margin of safety in positioning modern double-lumen endotracheal tubes. Anesthesiology. 1987;67(5):729–38.

    CAS  PubMed  Google Scholar 

  137. Herway ST, Benumof JL, Golts E, Manecke GR. Major positional obstruction of the trachea in a patient with a right-sided aortic arch and kommerell’s diverticulum. J Cardiothorac Vasc Anesth. 2015;29(1):146–8.

    PubMed  Google Scholar 

  138. Gross RE. Surgical treatment for dysphagia lusoria. Ann Surg. 1946;124:532–4.

    PubMed Central  Google Scholar 

  139. Bailey CP, Hirose T, Alba J. Re-establishment of the continuity of the anomalous right subclavian artery after operation for dysphagia lusoria. Angiology. 1965;16(9):509–13.

    CAS  PubMed  Google Scholar 

  140. Esposito RA, Khalil I, Galloway AC, Spencer FC. Surgical treatment for aneurysm of aberrant subclavian artery based on a case report and a review of the literature. J Thorac Cardiovasc Surg. 1988;95(5):888–91.

    CAS  PubMed  Google Scholar 

  141. Hallman GL, Cooley DA. Congenital aortic vascular ring. Surgical considerations. Arch Surg. 1964;88:666–74.

    CAS  PubMed  Google Scholar 

  142. Mok CK, Cheung KL, Kong SM, Ong GB. Translocating the aberrant right subclavian artery in dysphagia lusoria. Br J Surg. 1979;66(2):113–6.

    CAS  PubMed  Google Scholar 

  143. Fukuhara S, Patton B, Yun J, Bernik T. A novel method for the treatment of dysphagia lusoria due to aberrant right subclavian artery. Interact CardioVasc Thorac Surg. 2013;16(3):408–10.

    PubMed Central  PubMed  Google Scholar 

  144. Backer CL, Ilbawi MN, Idriss FS, DeLeon SY. Vascular anomalies causing tracheoesophageal compression. Review of experience in children. J Thorac Cardiovasc Surg. 1989;97(5):725–31.

    CAS  PubMed  Google Scholar 

  145. Backer CL, Hillman N, Mavroudis C, Holinger LD. Resection of kommerell’s diverticulum and left subclavian artery transfer for recurrent symptoms after vascular ring division. Euro J Cardiothorac Surg. 2002;22(1):64–9.

    CAS  Google Scholar 

  146. Wong PH, Lee JW. Right aortic arch and kommerell’s diverticulum. Thorax. 1983;38(7):553–5.

    PubMed Central  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

Dr. Milner received honorarium from WL Gore and Medtronic. All other authors had nothing to disclose.

Author information

Authors and Affiliations

  1. Department of Surgery, Section of Cardiac and Thoracic Surgery, University of Chicago, 5841 Maryland Avenue, Suite E-500/MC5040, Chicago, IL, 60637, USA

    Akiko Tanaka & Takeyoshi Ota

  2. Department of Surgery, Section of Vascular Surgery, University of Chicago, Chicago, IL, USA

    Ross Milner

Authors
  1. Akiko Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ross Milner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takeyoshi Ota
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takeyoshi Ota.

Additional information

This review was submitted at the invitation of the editorial committee.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tanaka, A., Milner, R. & Ota, T. Kommerell’s diverticulum in the current era: a comprehensive review. Gen Thorac Cardiovasc Surg 63, 245–259 (2015). https://doi.org/10.1007/s11748-015-0521-3

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11748-015-0521-3

Keywords

Search

Navigation