TAA 3. Endovascular Repair of Kommerell Diverticulum With or Without an Aberrant Left Subclavian Artery in a Right-Sided Aortic Arch: Report of Four Cases

Abstract

Right-sided 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 diverticulum (KD), is often found in performing imaging for other reasons and usually remains asymptomatic. However, KD may predispose to aortic aneurysm, dissection, or rupture. We reviewed the clinical results of four patients with KD with or without an aberrant LSA in a right-sided aortic arch who underwent endovascular treatment. From May 2013 to April 2019, four patients underwent endovascular treatment for KD in a right-sided aortic arch, with or without an aberrant LSA. The four patients underwent endovascular aortic repair. The first patient 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 in the right subclavian artery (RSA) as a radiopaque marker delineating the proximal extent of the landing zone. The second patient suffered from foreign body sensation and underwent endovascular aortic repair with stent graft implantation, embolization of the aberrant LSA and KD, and preservation of the RSA with chimney technique. The third patient underwent endovascular repair and preservation of the LSA, RSA, and right carotid artery with chimney technique. A type IA endoleak was found during the operation and was treated with stent graft implantation. The last patient had a right-sided aortic arch with KD, without an aberrant LSA, and underwent endovascular repair without reconstruction of the LSA. There were no cases of death, left arm ischemia, or neurologic deterioration in any of the patients. Endovascular treatment yielded a relatively satisfactory outcome in patients with a KD-related aneurysm, with or without an aberrant LSA, in a right-sided aortic arch. The choice for each strategy should be based on the patient’s individual anatomy and risks.