Hybrid Repair With Endovascular Debranching of the Aberrant Right Subclavian Artery for Complicated Type B Aortic Dissection in Patients With Kommerell's Diverticulum.
PURPOSE
Aberrant right subclavian artery (ARSA) associated with Kommerell's diverticulum (KD) is a common congenital arch anomaly. It can be complicated by type B aortic dissection (TBAD) or aneurysmal formation at its ostium. Recently, hybrid repair with thoracic endovascular aortic repair (TEVAR) has appeared to be more favorable. Due to the normal anatomic proximity of the ARSA to the left subclavian artery (LSA) orifice in KD, coverage of the bilateral subclavian arteries (SCAs) to obtain an adequate proximal landing zone (PLZ) is usually required, and double cervicotomy for SCA revascularization potentially increases the risk of complications.


TECHNIQUE
This technique was demonstrated on a 50-year-old man presenting with progressive aneurysmal formation of KD with ARSA after chronic TBAD. A 3-step technique, namely left cervical debranching with a left common carotid artery to LSA bypass graft, TEVAR, and an LSA-to-ARSA endovascular debranching with a self-expanding covered stent by a through-and-through wire from the right brachial artery to the bypass graft, was performed in a 1-stage repair to cover the primary tear of TBAD and preserve the bilateral SCAs. The postoperative course was uneventful.


CONCLUSION
This technique can prevent complications from double cervicotomy and achieve an adequate PLZ with preservation of the bilateral SCAs for TEVAR.
['Chien|Yu-Chen|YC|', 'Chou|Nai-Kuan|NK|', 'Wu|I-Hui|IH|0000-0003-4367-9108']
D000784:Aneurysm, Dissecting D001013:Aorta, Thoracic D019917:Blood Vessel Prosthesis Implantation D018376:Cardiovascular Abnormalities D004240:Diverticulum D057510:Endovascular Procedures D006801:Humans D008297:Male D008875:Middle Aged D013348:Subclavian Artery D016896:Treatment Outcome
hybrid repair thoracic endovascular aortic repair Kommerell’s diverticulum