A Hybrid Approach to Right-sided Aortic Arch Aneurysm Using Bilateral Carotid to Subclavian Bypass with a Customized Fenestrated Thoracic Endovascular Aortic Repair Device

We present a hybrid approach to the management of an aortic aneurysm in a right-sided aortic arch with aberrant left subclavian artery and associated Kommerell's diverticulum. The aneurysm extended from the origin of the left common carotid artery to the mid-descending thoracic aorta. A bilateral carotid to subclavian artery bypass was performed followed by endovascular placement of a customized fenestrated thoracic endovascular aortic repair device (TEVAR, Cook Medical, Australia). Endovascular stents (Viabahn, Gore Medical, Arizona) were placed in the carotid arteries bilaterally and Amplatzer II plugs (AGA Medical Corporation) were used to occlude the subclavian arteries. Follow-up imaging at 1 month revealed no evidence of endoleak.

Customized thoracic endovascular aortic repair - hybrid approach - right-sided aortic aneurysm

Publication History

Article published online:
26 March 2021

• References

• 1 Wu JY, Chen HY, Shu CC, Yu CJ. Kommerell diverticulum, right-sided aorta, and left aberrant subclavian artery in a patient with dysphagia. J Thorac Cardiovasc Surg 2010;139:e97-8.
• 2 Cruz Ciria S, Guillén Subirán ME, Zaragozano Guillén R, Hilario González J. Hybrid treatment of a symptomatic aneurysm of a Kommerell's diverticulum. Radiologia 2013;55:261-4.
• 3 Ferrero E, Ferri M, Viazzo A, Carbonatto P, Pecchio A, Casabona R, et al. Aneurysm of the aberrant right subclavian artery: Surgical and hybrid repair of two cases in a single center. Ann Vasc Surg 2011;25:839.e5-9.
• 4 Knight L, Edwards JE. Right aortic arch. Types and associated cardiac anomalies. Circulation 1974;50:1047-51.
• 5 Barr JG, Sepehripour AH, Jarral OA, Tsipas P, Kokotsakis J, Kourliouros A, et al. A review of the surgical management of right-sided aortic arch aneurysms. Interact Cardiovasc Thorac Surg 2016;23:156-62.
• 6 Cinà CS, Althani H, Pasenau J, Abouzahr L. Kommerell's diverticulum and right-sided aortic arch: A cohort study and review of the literature. J Vasc Surg 2004;39:131-9.