Endovascular Repair of a Right-Sided Descending Thoracic Aortic Aneurysm With a Right-Sided Aortic Arch and Aberrant Left Subclavian Artery

Naoum, Joseph J.; Parenti, Jennifer L.; LeMaire, Scott A.; Coselli, Joseph S.

doi:10.1016/j.athoracsur.2007.09.032

Cited by 51 publications

(44 citation statements)

References 5 publications

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“…To our knowledge, only few cases of TEVAR of this type of pathology were reported. Okada [6] first demonstrated the feasibility of endovascular repair as well as other authors, performing mostly hybrid procedures [7,8]. Only in 2 cases, a total endovascular procedure [9,10], confirmed that TEVAR is a viable and safe alternative to open surgical repair in these rare and complex cases.…”

Section: Discussionmentioning

confidence: 84%

Successful 36 Months Result of Debranching TEVAR for Kommerell?s Diverticulm with the Aberrant Left Subclavian Artery

Takai¹

2015

J Vasc Med Surg

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A case of successful endovascular repair of right aortic arch with the aberrant left subclavian artery (ALSA) arising from Kommerell's diverticulum (KD). Our strategy consisted of coil embolization for the orifice of the ALSA, put the bypass between left common carotid artery and left subclavian artery and exclusion of KD by stent graft insertion. Enhanced computed tomography scan 36 months after the operation showed successful exclusion of KD, patency of the bypass graft, and no evidence of endoleak.Endovascular repair can be a safe and effective treatment for aortic disease with challenging anatomy in the midterm, avoiding the need for a complex open surgery procedure. It is very rare in this successful case with midterm result we presented.

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Section: Discussionmentioning

confidence: 84%

Successful 36 Months Result of Debranching TEVAR for Kommerell?s Diverticulm with the Aberrant Left Subclavian Artery

Takai¹

2015

J Vasc Med Surg

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“…The application of thoracic endografts for the treatment of congenital anomalies is less commonly reported. Chiesa et al 11 and Naoum et al 12 have both reported cases of TEVAR performed in patients with right-sided aortic arches and right-sided descending thoracic aortas. In both cases, an aneurysm appears to have involved a Kommerell's diverticulum from which an aberrant left SCA arose to course in a retroesophageal fashion.…”

Section: Discussionmentioning

confidence: 97%

Endovascular repair of a Kommerell's diverticulum in a patient with a left-sided aortic arch and right-sided descending thoracic aorta

Riesenman

Campbell

2009

Journal of Vascular Surgery

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Thoracic aortic anomalies are rare and may be associated with pathologic vascular conditions necessitating intervention. We present a case of a patient with a left aortic arch, right descending thoracic aorta, and a Kommerell's diverticulum giving rise to an aberrant right subclavian artery. The Kommerell's diverticulum was successfully managed with a right carotid to subclavian artery bypass and thoracic endograft exclusion.

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“…The left subclavian artery may originate from a diverticulum, which may be prone to aneurysmal degeneration. [33][34][35] Supra-aortic branches may also pass retroesophageally to traverse the midline. There have been several case descriptions of hybrid repairs in patients with right-sided aortic arches.…”

Section: Treatment Of Aortic Pathology With Aberrant Arch Anatomymentioning

confidence: 99%

Open techniques for arch vessel reconstruction during thoracic endovascular aneurysm repair (TEVAR)

Vallabhaneni

Sánchez

2010

Journal of Vascular Surgery

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Over the past several years, the use and applications of thoracic endovascular grafts have increased significantly. There are now three FDA approved devices for thoracic endovascular aneurysm repair (TEVAR) available in the United States. These new devices have allowed us to expand the number of patients as well as the conditions we treat with this technology. However, many patients are not candidates for traditional endovascular repair because of unsuitable anatomy for use of these devices. Commonly, this is due to an inadequate proximal landing zone on the aortic arch. The recommended proximal landing zone for thoracic endograft devices is typically 2 to 3 cm of seal. To achieve this proximal landing zone, up to 40% of thoracic aneurysms may require coverage of critical supra-aortic arch vessels including or proximal to the left subclavian artery. 1 In this article, we will discuss the open surgical alternatives and techniques available in managing the proximal arch vessels in patients who have complex thoracic aortic anatomy. THORACIC ANEURYSMS ENCROACHING OR INVOLVING THE ORIGIN OF THE LEFT SUBCLAVIAN ARTERYThere has been considerable debate over the safety of coverage of the left subclavian artery. 2-6 The Society for Vascular Surgery ® (SVS) suggests routine preoperative revascularization for all elective TEVAR patients. 7 There are many ways to revascularize the subclavian artery depending on the individual patient's anatomy. The operations most commonly performed in these situations are transposition of the subclavian artery to the carotid artery or a carotidsubclavian bypass using a prosthetic graft. Both of these have excellent long-term outcomes with long-term patency of carotid-subclavian bypass being 86% and subclaviancarotid transposition approaching 100% in the hands of experienced surgeons. [8][9][10][11][12] Bypass with prosthetic grafts should be performed in patients with very proximal vertebral artery takeoffs, which prohibit subclavian artery transection proximally through a supraclavicular approach (Fig 1). A bypass procedure should also be preferentially used in patients who have a patent coronary bypass graft originating from the left internal mammary artery to help prevent coronary ischemia during clamping. Axillary-axillary artery bypasses and subclavian-subclavian artery bypasses have also been described in the literature for revascularization. 13 A type II endoleak may occur if the subclavian artery is not ligated proximally during revascularization. Carotidsubclavian bypass allows left brachial access to the aorta, which may be useful for embolization of the subclavian artery after coverage with an aortic endograft. In emergent situations where no revascularization is performed, coil embolization via the brachial artery can be performed if an endoleak persists at follow-up imaging.When performing these operations, a few technical tips may help reduce the risk of complications. One of the major risks of either of these procedures is a phrenic nerve injury. The phrenic nerve is visuali...

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Endovascular Repair of a Right-Sided Descending Thoracic Aortic Aneurysm With a Right-Sided Aortic Arch and Aberrant Left Subclavian Artery

Cited by 51 publications

References 5 publications

Successful 36 Months Result of Debranching TEVAR for Kommerell?s Diverticulm with the Aberrant Left Subclavian Artery

Successful 36 Months Result of Debranching TEVAR for Kommerell?s Diverticulm with the Aberrant Left Subclavian Artery

Endovascular repair of a Kommerell's diverticulum in a patient with a left-sided aortic arch and right-sided descending thoracic aorta

Open techniques for arch vessel reconstruction during thoracic endovascular aneurysm repair (TEVAR)

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