Endovascular Aortic Repair of the Kommerell Diverticulum in Right-side Aortic Arch: Report of 4 Cases

Abstract

Introduction: Right-side aorta is a rare congenital malformation that is present in approximately 0.5% to 1% of the general population, and approximately half of these cases are associated with an aberrant left subclavian artery (LSA). An obviously aneurysmal change at the origin of the aberrant LSA, known as Kommerell's diverticulum (KD), is often found when performing imaging for other reasons and usually remains asymptomatic. However, Kommerell's diverticula may predispose toward aortic aneurysm, dissection or rupture. We reviewed the clinical results of 4 patients with KD in a right-side aortic arch with or without an aberrant LSA, who underwent endovascular treatments. Methods: From May 2013 to April 2019, 4 patients underwent endovascular treatments for the KD in right-side aortic arch, with or wihout an abberrant LSA arising from the diverticulum. Results: Four patients all underwent endovascular aortic repair. The first patient was asymptomatic, and received Amplatzer vascular plug embolization of the aberrant LSA and endovascular repair of the KD, with a 0.035-inch, 260-cm stiff wire intentionally placed into the right subclavian artery as a radiopaque marker delineating the proximal extent of the landing zone. The second one who suffered from foreign body sensation underwent endovascular aortic repair with a stent-graft implantation, embolization of the aberrant LSA and KD, and preserving the right subclavian artery (RSA) with chimney technique. The third patient was complicated with Debakey type III aortic dissection, and underwent endovascular repair with preserving the LSA, RSA and right carotid artery with chimney techniques. Type Ia endoleak was found during the operation, and was treated with a stent graft implantation. The last patient showed a KD in a right aortic arch without an aberrant LSA, and underwent conventional endovascular repair in a RAO 55o working place. There was no death, left arm ischemia, or neurological deterioration in all four patients. Conclusion: Endovascular treatment yielded a relatively satisfactory outcome in patients with a Kommerell's diverticulum related aneurysm in a right-side aortic arch. The choice for each strategy should be based on the patients' individual anatomy and risks.Figure 2Case 4 TEVAR with the coverage of the KD.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Disclosure: Nothing to disclose