Two stage surgical treatments for a chronic type B dissecting aortic aneurysm with aberrant right subclavian artery and Kommerell Diverticulum ; a case report

• Published in: TOYAMA MEDICAL JOURNAL Vol. 29; no. 1; pp. 40 - 43
• Main Authors: Katsunori TAKEUCHI, Akio YAMASHITA, Koji SEKI, Kimimasa SAKATA, Naoki YOSHIMURA
• Format: Journal Article
• Language: Japanese
• Published: University of TOYAMA 31.03.2018
• ISSN: 2189-2466

[Abstract] We report a case of two stage operations for a chronic type B dissecting aortic aneurysm with aberrant right subclavian artery (ARSA) and Kommerell's diverticulum (KD). A 62-year-old man with a type B aortic dissection from 9 years before underwent follow-up Computed Tomography (CT) revealing aortic arch with KD expanded to 53mm and aberrant right subclavian artery expanded to 23mm in diameter. We performed two stage operations. In the first, we performed ARSA division at the proximal part of vertebral artery and transposed the distal end to right common carotid artery transposition. Subsequently, we performed replacement of descending aortia and over sewing of the aneurysmal of the origin ARSA under circulatory arrest. KD with ARSA is a rare anomaly of the aortic arch, and it may develop complications such as distal embolization, subclavian-esophageal fistula, dissection and rupture. We performing in two stages, subclavian reconstruction before the intrathoracic repair would be expected to reduce the subsequent risk of distal ischemia or subclavian steal.