Endovascular repair of type A aortic intramural hematoma accompanied by aberrant right subclavian artery and Kommerell\u2019s diverticulum: a case report

Sizheng Xiong,Daoquan Wang,Jun Li

doi:10.1186/s12872-020-01504-2

Abstract

BackgroundThe lesions of aberrant right subclavian artery, Kommerell’s diverticulum and type A aortic intramural hematoma are rare, and we usually treat them with open surgery. In some cases patients have increased risk to undergo surgery, the experiences of endovascular or medical treatment are limited.Case presentationHere we reported a case of a 53-year-old man with these three entities present with chest and back ache and attempted a novel approach, thoracic endovascular aortic repair, in the absence of surgical treatment. The patient lived over 5 years and this case provides initial experience and lesson about the endovascular and medical management of the uncommon and dangerous disease- type A aortic intramural hematoma with aortic congenital malformation.ConclusionThoracic endovascular aortic repair with medical treatment may be a potential alternative approach for type A aortic intramural hematoma.

Highlights

The lesions of aberrant right subclavian artery, Kommerell’s diverticulum and type A aortic intramural hematoma are rare, and we usually treat them with open surgery
Aortic intramural hematoma (IMH) is a clinical entity characterized by hemorrhage within the media of aortic wall in absence of an intimal disruption, generally caused by rupture of the vasa-vasorum or intimal fracture induced by the progress of the atherosclerotic plaque, and Stanford type A IMH (TAIMH) is defined as the lesion involving the ascending aorta (Fig. 1a) [1]
Discussion the treatment of TAIMH were under consensus in different regions, surgery was advocated when TAIMH was accompanied by the Penetrating atherosclerotic ulcer (PAU), which was a predictor of progress of the TAIMH [3]

Summary

Introduction

The lesions of aberrant right subclavian artery, Kommerell’s diverticulum and type A aortic intramural hematoma are rare, and we usually treat them with open surgery. Conclusion: Thoracic endovascular aortic repair with medical treatment may be a potential alternative approach for type A aortic intramural hematoma.

Results

Conclusion