Thoracic Endovascular Aortic Repair for Kommerell’s Diverticulum with Right-sided Aortic Arch:The Efficacy of Angulation Control

Abstract

A 68-year-old woman with hoarseness was referred to our hospital because of abnormal findings on chest computed tomography (CT), and esophageal compression on gastrointestinal endoscopy. She was diagnosed with Kommerell’s diverticulum with right-sided aortic arch and aberrant left subclavian artery by contrast enhanced CT. The diameter of the origin of the diverticulum was 30 mm and the distance from the tip of the diverticulum to the opposite aortic wall was 52 mm. We performed thoracic endovascular aortic repair (TEVAR) because of the hoarseness and large diverticulum. Following the left carotid-axillary bypass, a Gore TAG Conformable active control system 37 mm–150 mm was inserted covering the right subclavian artery. The angulation control was used to adapt the stent graft to the steep aortic arch before deployment, and the right subclavian artery was stented (chimney technique) for preservation of the blood flow. After that, coil embolization of the left subclavian artery was performed. Postoperative contrast enhanced CT showed no endoleak, and the hoarseness disappeared. For the two years since the surgery, the diverticulum has not enlarged and she has been doing well.