Total Arch Replacement Using the Fenestrated Frozen Elephant Trunk Technique for Stanford Type A Aortic Dissection with Aberrant Right Subclavian Artery and Kommerell's Diverticulum

Hirotaka OHASHI; Hiroaki KANEYAMA; Masayoshi WAGA; Yuki AKAGUMA; Koki IKEBATA; Kiyoshi KOIZUMI; Hirotsugu FUKUDA; Hideyuki SHIMIZU

Return

Total Arch Replacement Using the Fenestrated Frozen Elephant Trunk Technique for Stanford Type A Aortic Dissection with Aberrant Right Subclavian Artery and Kommerell's Diverticulum

VernacularTitle:右鎖骨下動脈起始異常にKommerell憩室を伴うStanford A型大動脈解離に対してfenestrated Frozen Elephant Trunk法による全弓部置換術を施行した1例
Author: Hirotaka OHASHI ¹ ; Hiroaki KANEYAMA ² ; Masayoshi WAGA ¹ ; Yuki AKAGUMA ² ; Koki IKEBATA ² ; Kiyoshi KOIZUMI ² ; Hirotsugu FUKUDA ¹ ; Hideyuki SHIMIZU ³
Author Information

1. Department of Cardiac and Vascular Surgery, Dokkyo Medical University
2. Department of Cardiovascular Surgery, Japanese Red Cross Ashikaga Hospital
3. Department of Cardiac and Vascular Surgery, Keio University School of Medicine
Keywords: Kommerell's diverticulum; aberrant right subclavian artery; aortic dissection; fenestrated Frozen Elephant Trunk technique
From:Japanese Journal of Cardiovascular Surgery 2025;54(2):82-86
CountryJapan
Language:ja
Abstract: A 45-year-old man with no history developed pain and paralysis in his left lower extremity. When he visited his previous physician, CT was performed, which showed Stanford type A aortic dissection with an aberrant right subclavian artery and Kommerell's diverticulum and narrowing of the true lumen of the left common iliac artery. He was accompanied by lower limb symptoms. He was then rushed to our hospital for emergency surgery. The operation was planned and performed in two stages. A median sternotomy was conducted, and cardiopulmonary bypass using the right common femoral artery, left axillary artery, and right atrium was initiated. Deep hypothermic circulatory arrest and antegrade selective cerebral perfusion were performed. The tear's entry was located in the distal arch of the aorta. The aortic arch was transected between the left common carotid and left subclavian arteries. We inserted an open stent graft to cover the diverticulated origin of the right subclavian artery. The left subclavian artery was reconstructed using a fenestration technique. The ascending aorta, aortic arch, and right and left common carotid arteries were reconstructed using a 4-branch prosthesis graft. The right subclavian artery was reconstructed through the thoracic cavity. On the day after the surgery, we performed percutaneous embolization of the right subclavian artery distal to the Kommerell's diverticulum. Postoperative CT showed no endoleakage or blood flow to the Kommerell's diverticulum. The patient's postoperative course was uneventful.