First MDCT evidence of ruptured aberrant left subclavian artery aneurysm in right aortic arch, Kommerell’s diverticulum and extrapleural hematoma treated by emergency thoracic endovascular aortic repair

Abstract

Spontaneous ruptured aneurysm involving an aberrant subclavian artery with a right-sided aortic arch and Kommerell’s diverticulumis a rare life-threatening condition that can be treated successfully if promptly identified. Multidetector Computed Tomography angiography is the first line imaging modality of thoracic vascular anomalies diagnosis. We report the case of a 74-year-old man suffering from this emergency ondition with mediastinal hematoma mostly extending to the left-side extrapleural cavity. The patient underwent successful emergency thoracic endovascular aortic repair and an Amplatzer vascular plug was placed into the first segment of the ALSA. Post-procedural imaging showed complete exclusion of the aneurysm. Emergency endovascular repair can be effective in such cases.

Emergent hybrid surgical approaches for non-dissecting ruptured Kommerell's aneurysm: a case report series

“…However, it does not solve the problem of the proximal landing zone and has been associated with complications such as branch occlusion, endoleaks, and stent-graft migration [31,33]. One of its main advantages is that it can be performed in one or two stages, depending on the patient's surgical risk and general clinical condition [20].…”

“…Sica et al [20] reported the case of a 74-year-old male patient with a saccular 70 mm Type II rKA associated with an anomalous course of the left brachiocephalic vein, which coursed posteriorly to the ascending aorta, and joined the right brachiocephalic vein to form the superior vena cava. Besides, a hematoma of the descending aorta was found, forming an extrapleural hematoma.…”

“…Due to the implications of this condition, including death, emergent surgical repair is usually granted. Some elective surgical approaches have been proposed; however, evidence regarding the optimal emergent management for KA and rKA is mainly based on isolated case reports or a few KD cohorts, as shown in Table 1 [2,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22].…”