SS01 - Approaches in the Treatment of Aberrant Subclavian Artery and Kommerell’s Diverticulum

Objectives: To examine contemporary outcomes after invasive treatment of Aberrant Subclavian Artery (ASA) and Kommerell’s Diverticulum (KD).

Methods: Patients who underwent intervention for ASA/KD (2000-2020) were identified through the Vascular Low Frequency Disease Consortium (VLFDC. Patient characteristics by treatment modality were compared and an assessment of early and mid-term technical and clinical outcomes was performed.

Results: 129 patients were identified at 16 institutions. Mean patient age was 58 with 51% males. A right-sided arch was treated in 13%. Mean transverse size of KD was 39mm (range 5-108). The most common indication for treatment was symptoms (60%); dysphagia was the most common (45%), followed by pain (15%), dyspnea (13%), dysphonia (7%). Females were more often symptomatic (78% vs. 48%; p = 0.0006). The second most common indication was aneurysm size (48%). An open procedure (Open) was performed in 32(24%) cases; the most common repair was ASA ligation with subclavian revascularization in 14(69%) followed by aortic graft/patch repair and subclavian revascularization in 7(22%), primary aortic repair and subclavian revascularization in 6(19%), carotid/subclavian bypass alone in 3(9%) and subclavian transposition in 2(6%). An endovascular or hybrid approach (Endo/Hybrid) was performed in 93(76%); the most common repair was thoracic endograft and carotid-subclavian bypass in 78(84%). Staged repair was more common than same setting repair (41 vs. 28%). Endoleaks occurred in 26% of the Endo/Hybrid repairs during the 34 month follow-up period. Younger patients (50 vs. 61 years of age; p = 0.002), female patients (66% vs. 44%; p = 0.04) and symptomatic patients (86% vs. 56%; p = 0.003) more often underwent Open rather than Endo/Hybrid. Patients undergoing Endo/Hybrid had longer length of stay than those undergoing Open (11 vs. 7 days; p = 0.03). There were 3 subclavian occlusions (2.5%) and 18 (15%) reinterventions with no difference between Open or Endo/Hybrid groups. Female patients were more likely to require a reintervention (22% vs. 8%; p = 0.03). At mean follow-up of 35 months (range 1-163) 13(10%) patients had died.

Conclusions: Patients undergoing invasive treatment for ASA and/or KD were overall relatively young and most often treated for symptoms. Endo/Hybrid cases were performed most often and frequently in a staged fashion but associated with a moderate rate of endoleak and prolonged length of stay. Gender differences exist with respect to symptoms and reinterventions. Despite newer endovascular and hybrid approaches, for good risk patients, especially female patients, an open surgical approach appears to harbor distinct durability and reintervention advantages.