Vascular Rings in Adults: Outcome of Surgical Management.

Abstract

BACKGROUND\nLimited data exists on the management of vascular rings (VR) in adults. We reviewed our experience of surgical treatment of these patients.\n\n\nMETHODS\nAll adult patients with VR (n=65) that underwent surgery [mean age 45±16years, 33(51%) females] were retrospectively reviewed from 1/1972 to 1/2018. Anatomic variants were: right arch with aberrant left subclavian artery (SA) and Kommerell s diverticulum (KD) (n=22, 34%), left arch with aberrant right-SA and KD (n=20, 31%), double aortic arch (n=12, 18%), right arch with mirror imaging and persistent ligamentum off KD (n=7, 11%), and others (n=4, 6%). Indications for operation included dysphagia (n=43, 63%), respiratory symptoms (n=28, 43%), aneurysmal KD (n=12, 18%) and dissection/rupture (n=7, 11%).\n\n\nRESULTS\nKommerell s diverticulum was found in 51(78%) patients. Surgical approach included left-thoracotomy (n=50, 77%), right-thoracotomy (n=7, 11%), sternotomy (n=5, 8%) and hybrid-repair (n=3, 5%). A 2-stage repair with carotid-SA transposition followed by transthoracic KD excision was done in 51% of aberrant-SA (n=23). There was 1 early death. Morbidity included recurrent laryngeal nerve injury (n=5, 8%) and chylothorax (n=3, 5%). Symptomatic improvement occurred in 97%. Survival was 96.1%, 85.0%, and 73.4% at 1, 5, and 10years respectively. Dysphagia recurred in 9(14%) which included 7(11%) with esophageal dysmotility.\n\n\nCONCLUSIONS\nRepair of VR in adults can be performed safely. Dysphagia is the most common symptom and improves in the majority after repair. Excision of KD and aberrant vessel is the preferred approach to prevent acute aortic events or recurrent symptoms. Early operation should be considered with esophageal compression to avoid late dysmotility.