Abstract
Right aortic arches are associated with an aberrant left subclavian artery, the dilated root of which is known as Kommerell’s diverticulum (KD). Such anomalies have been treated with open surgical resections and replacements, but recently, endovascular treatments for KD have been reported. We herein report a case of a hybrid endovascular treatment of KD, and the use of N-Butyl-2-Cyanoacrylate (NBCA) embolization for postoperative type 2 endoleaks. A 79-year-old male, who had been followed for hepatocellular carcinoma was diagnosed to have Kommerell’s diverticulum with a right aortic arch (Edwards IIIB type), and was admitted for surgery. A CT scan showed the KD with a maximum diameter of 40 mm. A biaxillary cross-bypass, a thoracic endovascular aortic repair and coil embolization of the left subclavian artery were performed. CT images taken seven days after the surgery showed a type II endoleak from a left subclavian artery, and the one-month postoperative CT images showed an enlarged KD. Therefore, a second operation was performed, wherein an NBCA-lipiodol mixture was injected into the KD cavity, and additional coil embolization was performed. CT images taken two-months after the second operation showed remaining endoleaks, and an intraoperative angiogram of the third operation suggested the KD had an intercourse with an intercostal artery. NBCA and coil embolization were performed again. One year has passed since the third operation, and there is still a slight blood flow into the KD, but there has been no evidence of enlargement of the KD. Thus, we believe that hybrid repair for KD is a safe and useful procedure, and our findings confirmed the usefulness of NBCA embolization for endoleaks in the thoracic region.
