Monaco Mario, Lillo Stefano, La Marca Giordano Agostino, Contaldo Antonio, Schiavone Vincenzo
Department of Vascular Surgery, Pineta Grande Hospital, Castelvolturno (CE), Italy.
Department of Vascular Surgery, Pineta Grande Hospital, Castelvolturno (CE), Italy.
Ann Vasc Surg. 2014 Jul;28(5):1323.e1-5. doi: 10.1016/j.avsg.2014.01.023. Epub 2014 Feb 15.
A case of successful total endovascular repair of a right-sided descending thoracic aorta aneurysm (r-DTAA) with Kommerell diverticulum and aberrant left subclavian artery (ALSA) was reported. Few cases of this very rare pathology were reported, mostly describing a hybrid treatment, with only 2 cases of total endovascular repair performed to date.
Our strategy consisted of endovascular ALSA occlusion, without preventive revascularization, and r-DTAA exclusion by 2 endoprosthesis implanted in a telescopic fashion, first the distal one, to achieve a relative straightening of the arch and support the proximal endoprosthesis, and then the proximal one, close to the right subclavian origin. Completion angiography and 12-month computed tomography scan showed successful exclusion, patency of epiaortic vessels, and absence of endoleak.
Endovascular repair can be a safe and effective treatment for aortic disease with challenging anatomy, avoiding the need for a complex open surgery procedure.
报道了一例成功通过血管腔内完全修复右侧降胸主动脉瘤（r-DTAA）合并Kommerell憩室及迷走左锁骨下动脉（ALSA）的病例。这种非常罕见的病理情况报道较少，大多描述的是杂交治疗，迄今为止仅2例进行了完全血管腔内修复。
我们的策略包括血管腔内闭塞ALSA，不进行预防性血运重建，通过以套叠方式植入2个血管内支架来排除r-DTAA，首先植入远端支架以实现主动脉弓相对伸直并支撑近端血管内支架，然后植入近端支架，靠近右锁骨下动脉起始处。完成血管造影及12个月的计算机断层扫描显示成功排除病变、主动脉弓上血管通畅且无内漏。
血管腔内修复对于解剖结构复杂的主动脉疾病可以是一种安全有效的治疗方法，避免了复杂的开放手术。
