Hybrid endovascular treatment of aneurysm degeneration in a rare right-aortic arch anomaly with Kommerell diverticulum

Abstract

We present a hybrid endovascular approach to a 6.5-cm aneurysm of the right-sided aortic arch with an aberrant left subclavian artery arising from a Kommerell diverticulum, connected to the left pulmonary artery through the ligamentum arteriosum. The two-step procedure consisted of a bilateral carotid-subclavian bypass, followed by an ascending aorta-bicarotid bypass and completed by an endovascular exclusion of the aneurysms by covering the whole aortic arch and its branches. The patient had no complications and is asymptomatic 21 months after surgery. Hybrid procedures may be helpful in complex aortic arch pathologies, reducing complications of challenging open surgery.

Results of aberrant right subclavian artery aneurysm repair

“…[20][21][22][23][24][25] In a recent systematic review collecting overall 31 endovascular or hybrid published cases for aneurysms on aberrant subclavian arteries, Yang et al 1 found that the hybrid approach, including thoracic stent grafting with distal subclavian ligation, was the most frequently used.…”

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

“…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.…”

Two Cases of Thoracic Aortic Aneurysm with Right Aortic Arch: Comparison of Two Operative Strategies for Hybrid Thoracic Endovascular Repair

“…7) A few recent studies report the use of median sternotomy in hybrid therapies with a combination of cervical branch reconstruction and stent graft treatments. [8][9][10] Patients who require only median sternotomy have a major advantage. Neither of the patients required additional thoracotomy, and both surgeries were completed using only a mediastinal approach via median sternotomy.…”