PMID- 37310394
OWN - NLM
STAT- MEDLINE
DCOM- 20231004
LR  - 20231004
IS  - 1938-9116 (Electronic)
IS  - 1538-5744 (Print)
IS  - 1538-5744 (Linking)
VI  - 57
IP  - 8
DP  - 2023 Nov
TI  - Kommerell's Diverticulum in a Right-Sided Aortic Arch With an Aberrant Left 
      Subclavian Artery Hybrid Repair.
PG  - 954-959
LID - 10.1177/15385744231183310 [doi]
AB  - BACKGROUND: Kommerell's diverticulum (KD) with a right aortic arch (RAA) and 
      aberrant left subclavian artery (aLSCA) is a rare congenital anomaly of the 
      aortic arch. Treatment is not well defined due to its uncommon presentation, with 
      rupture and dissection risk rates of up to 53%. CASE SUMMARY: A 54-year-old male 
      with a history of chronic obstructive pulmonary disease (COPD) and hypertension 
      presented with difficulty breathing during exercise without dysphagia. Follow-up 
      computerized tomography angiogram (CTA) revealed the presence of a RAA and aLSCA 
      arising from the descending thoracic aorta with an adjacent 58 x 41-mm KD and 
      tracheal and esophageal displacement. Due to the size of the KD, risk of rupture, 
      unsuitable anatomy for total endovascular aortic repair (EVAR), and high COPD 
      burden, the patient was planned to undergo a hybrid surgical repair. Left common 
      carotid (LCCA) artery to LSCA bypass, full aortic debranching, LSCA embolization 
      and percutaneous thoracic endovascular aortic repair (TEVAR) were performed. 
      Successful device position and exclusion of the diverticulum and aneurysmal aorta 
      were observed after completion thoracic aortogram. 18-month follow-up CTA 
      demonstrated patency of the LSCA to LCCA bypass graft and arch vessel branches, 
      as well as stable exclusion of the KD. Persistence of a type II endoleak 
      originated at the right first posterior intercostal artery has been noted and is 
      being followed conservatively since no sac growth has occurred. CONCLUSION: We 
      highlight the presence of a KD with RAA and aberrant subclavian artery, a rare 
      congenital anatomic variation of the aortic arch with complex anatomy. Surgical 
      planning must be individualized according to comorbidities and anatomical 
      variations identified on imaging and 3D reconstructions.
FAU - Solano, Antonio
AU  - Solano A
AUID- ORCID: 0000-0002-1022-0985
AD  - Division of Vascular and Endovascular Surgery, Department of Surgery, University 
      of Texas, Dallas, TX, USA.
FAU - Pizano, Alejandro
AU  - Pizano A
AUID- ORCID: 0000-0001-8973-9335
AD  - Division of Vascular and Endovascular Surgery, Department of Surgery, University 
      of Texas, Dallas, TX, USA.
FAU - Azam, Jawaher
AU  - Azam J
AD  - Medical School, University of Texas Southwestern Medical Center, Dallas, TX, USA 
      Presented at the poster session of the Critical Issues America Annual Meeting. 
      Miami, FL, February 10-11, 2023. RINGGOLD: 25989
FAU - Gonzalez-Guardiola, Gerardo
AU  - Gonzalez-Guardiola G
AD  - Division of Vascular and Endovascular Surgery, Department of Surgery, University 
      of Texas, Dallas, TX, USA.
FAU - Siah, Michael
AU  - Siah M
AD  - Division of Vascular and Endovascular Surgery, Department of Surgery, University 
      of Texas, Dallas, TX, USA.
FAU - Chamseddin, Khalil
AU  - Chamseddin K
AD  - Division of Vascular and Endovascular Surgery, Department of Surgery, University 
      of Texas, Dallas, TX, USA.
FAU - Prakash, Vivek
AU  - Prakash V
AD  - Division of Vascular and Endovascular Surgery, Department of Surgery, University 
      of Texas, Dallas, TX, USA.
FAU - Kirkwood, Melissa L
AU  - Kirkwood ML
AD  - Division of Vascular and Endovascular Surgery, Department of Surgery, University 
      of Texas, Dallas, TX, USA.
FAU - Shih, Michael
AU  - Shih M
AD  - Division of Vascular and Endovascular Surgery, Department of Surgery, University 
      of Texas, Dallas, TX, USA.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20230613
PL  - United States
TA  - Vasc Endovascular Surg
JT  - Vascular and endovascular surgery
JID - 101136421
RN  - Aberrant subclavian artery
SB  - IM
MH  - Male
MH  - Humans
MH  - Middle Aged
MH  - Aorta, Thoracic/diagnostic imaging/surgery/abnormalities
MH  - Treatment Outcome
MH  - *Cardiovascular Abnormalities/complications/diagnostic imaging/surgery
MH  - Subclavian Artery/diagnostic imaging/surgery/abnormalities
MH  - Aortography/methods
MH  - *Pulmonary Disease, Chronic Obstructive
MH  - *Diverticulum/diagnostic imaging/surgery
PMC - PMC10543133
OTO - NOTNLM
OT  - Kommerell's diverticulum
OT  - aberrant subclavian artery
OT  - aortic arch aneurysm
OT  - aortic arch anomalies
OT  - hybrid repair
OT  - right aortic arch
OT  - thoracic endovascular aortic repair
OT  - total debranching
COIS- The author(s) declared the following potential conflicts of interest with respect 
      to the research, authorship, and/or publication of this article: M.L.K. is a 
      consultant for W.L. Gore & Associates The other editors of this article have no 
      relevant financial relationships to disclose.
EDAT- 2023/06/13 13:12
MHDA- 2023/10/04 06:43
PMCR- 2023/10/02
CRDT- 2023/06/13 10:53
PHST- 2023/10/04 06:43 [medline]
PHST- 2023/06/13 13:12 [pubmed]
PHST- 2023/06/13 10:53 [entrez]
PHST- 2023/10/02 00:00 [pmc-release]
AID - 10.1177_15385744231183310 [pii]
AID - 10.1177/15385744231183310 [doi]
PST - ppublish
SO  - Vasc Endovascular Surg. 2023 Nov;57(8):954-959. doi: 10.1177/15385744231183310. 
      Epub 2023 Jun 13.