International Society For Minimally Invasive Cardiothoracic Surgery

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Endovascular Repair For Kommerell's Diverticulum And An Aberrant Subclavian Artery
Masato Hayakawa1, Isao Nishijima1, Takaaki Nagano2, Kento Shinzato1, Ryo Ikemura1, Kazufumi Miyagi1, Kiyoshi Iha1.
1Chubu Tokushukai Hospital, Kitanakagusuku-son, Japan, 2Univercity of the Ryukyus Hospital, Nishihara-cho, Japan.

BACKGROUND:The coexistence of Kommerell's diverticulum (KD) and an aberrant subclavian artery (ASCA) is a rare congenital variation in vascular structure. We report our observations of thoracic endovascular repair (TEVAR) for KD associated with this anomaly. METHODS:We retrospectively reviewed all patients treated with endovascular repair for aneurysms associated with KD and having an ASCA at Chubu Tokushukai Hospital. RESULTS:Between June 2013 and October 2018, six consecutive patients underwent endovascular repair for KD associated with an ASCA anomaly. The mean age of patients was 59.811.3 years (range, 45-78 years), with an equal distribution of males and female patients. Five patients had a right-sided aortic arch. No patient, except one who developed an uncomplicated type-B aortic dissection (TBAD), exhibited any symptom. The technical success rate was 100%. Four patients required debranching TEVAR and two patients required TEVAR with chimney stent technique. There was no in-hospital death, 30-day postoperative stroke, or spinal cord ischemia. During the course of follow up (median, 25 months; range, 2-60 months), one patient underwent re-sternotomy for mediastinitis at two weeks after the intervention, and the patient with TBAD required two embolisms due to type-II endoleaks at one and three years after the operation. No all-cause deaths or dilatation of aneurysms were reported. CONCLUSIONS:Endovascular repair for aneurysms associated with KD and an ASCA was safe and effective, avoiding the need for a more complex procedure.

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