Endovascular Repair of an Aberrant Left Subclavian Artery Arising From a Kommerell’s Diverticulum in a Right-side Aortic Arch: Report of Three 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 3 patients of an aberrant LSA arising from a KD in a right-side aortic arch, who underwent endovascular treatments. Methods - A total of 3 patients underwent endovascular treatments for an aberrant LSA arising from a KD in a right-side aortic arch. One patient was asymptomatic, one suffered from foreign body sensation, and the last patient was complicated with Debakey type III aortic dissection. Results - Three patients all underwent thoracic endovascular aortic repair (TEVAR). One patient received Amplatzer vascular plug embolization of the aberrant LSA and endovascular repair of the KD. Another patient who suffered from foreign body sensation underwent TEVAR, embolization of the aberrant LSA and KD, and preserving the right subclavian artery (RSA) with chimney technique. The last patient underwent TEVAR and preserving the LSA, RSA and right carotid artery with chimney technique. There was no neurological deterioration at the discharge in all three patients. Conclusion - Endovascular treatment yielded a relatively satisfactory outcome in patients with an aberrant LSA and KD.