title: Endovascular repair of a right-sided descending thoracic aortic aneurysm associated with a right aortic arch and a left subclavian artery arising from a Kommerell's diverticulum.
abstract: This case report describes the endovascular repair of a right-sided descending thoracic aortic aneurysm associated with a right aortic arch and an aberrant left subclavian artery. A 76-year-old male with multiple comorbidities was incidentally found to have a right-sided descending thoracic aortic aneurysm with a maximum diameter of 6.2 cm. Additionally, there was a right aortic arch with a retroesophageal segment and separate arch branches arising in the following order: left common carotid artery, right common carotid artery, right subclavian artery, and left subclavian artery that was aberrant, arising from a Kommerrell's diverticulum. The aneurysm was successfully excluded by deployment of a Zenith TX1 36 x 32 x 20-mm stent-graft using wire traction technique via the left femoral and right brachial arteries in order to deal with two severe aortic angulations. At 18-month follow-up the patient was doing well, with aneurysm sac shrinkage to 5.9 cm and no signs of endoleak or migration. Endovascular repair of right-sided descending thoracic aortic aneurysms with a right arch and aberrant left subclavian artery is feasible, safe, and effective. In such rare configurations, which demand considerably increased technical dexterity and center experience, endovascular repair emerges as an attractive therapeutic option.
authors.affiliation: First Department of Surgery, Vascular Division, LAIKON Hospital, Athens University Medical School, 11 Zalokosta St., Psihico, Athens, 15452, Greece. chris_klonaris@yahoo.com
authors.forename: Chris
authors.initials: C
authors.lastname: Klonaris
authors.forename: Efthimios D
authors.initials: ED
authors.lastname: Avgerinos
authors.forename: Athanasios
authors.initials: A
authors.lastname: Katsargyris
authors.forename: Alexandros
authors.initials: A
authors.lastname: Matthaiou
authors.forename: Sotirios
authors.initials: S
authors.lastname: Georgopoulos
authors.forename: Vasileios
authors.initials: V
authors.lastname: Psarros
authors.forename: Elias
authors.initials: E
authors.lastname: Bastounis
mesh_terms: D000015:Abnormalities, Multiple; D000368:Aged; D015901:Angiography, Digital Subtraction; D001013:Aorta, Thoracic / Q000002:abnormalities*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D003287:Contrast Media; D004240:Diverticulum / Q000151:congenital*; D006801:Humans; D008297:Male; D013348:Subclavian Artery / Q000002:abnormalities*; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media