A 72-year-old man with a thoracoabdominal aortic aneurysm combined with an aberrant right subclavian artery, Kommerell's diverticulum, and angina pectoris during follow-up for peripheral arterial disease was successfully treated surgically by two-staged operation. First, we performed total arch replacement using cardiopulmonary bypass, systemic hypothermia, selective cerebral perfusion, and coronary artery bypass grafting. Secondly, we performed replacement of the thoracoabdominal aortic aneurysm using a partial cardiopulmonary bypass. The postoperative course was uneventful. This is apparently the first case of repair for the thoracoabdominal aortic aneurysm combined with an aberrant right subclavian artery and Kommerell's diverticulum.

A 71-year-old woman was admitted with sudden onset of abdominal pain. CT scan image and symptoms showed an impending ruptured suprarenal abdominal aortic aneurysm therefore we performed an emergency operation. The abdominal aorta was replaced with a trunk prosthetic graft with four branches for visceral and lumbar arteries. The post-operative course was uneventful. Pathological examination showed that the aorta had severe atherosclerotic changes. The fibrous tissues increased in the aneurysmal wall which was not consistent with the normal aorta. Intima and media of the aorta everted into the aneurysm. These findings suggested that aneurysm was caused by a penetrating atherosclerotic ulcer.