case_images: PMC10754508_01
case_images: Pre-interventional 3D model. Anterior (A), lateral (B), and posterior (C) views showing a right-sided aortic arch and supra-aortic vessels, in the following order of origin: the left common carotid artery, right common carotid artery, independent right subclavian artery, and finally an aberrant left subclavian artery with critical proximal stenosis and post-stenosis saccular aneurysm (1) in relation to a Kommerell's diverticulum (2).
case_images: fcvm-10-1309839-g001.jpg
case_images: PMC10754508_01_fcvm-10-1309839-g001.jpg
case_images: F1
case_images: A 3D model of the aorta was obtained to better study the case (Figure 1).
case_images: Post-interventional 3D model. Anterior (A), lateral (B), and posterior (C) views showing (1) the one-branch thoracic endograft (Castor, MicroPort ) in aorta with the branch placed in the right subclavian artery, extended with a covered stent, (2) Amplatzer Vascular Plug II, (3) in the left subclavian artery excluding Kommerell's diverticulum the poststenotic saccular aneurysm (therefore not visible in the model), and (4) left carotid-subclavian extra anatomical bypass.
case_images: fcvm-10-1309839-g002.jpg
case_images: PMC10754508_01_fcvm-10-1309839-g002.jpg
case_images: F2
case_images: Finally, from the left humeral access, a 14 mm Amplatzer Vascular Plug II was placed, excluding the Kommerell's diverticulum and the saccular aneurysm of the left subclavian artery (Figure 2, intraoperative images provided in Supplementary Image S1-S4).
case_images: ECG-gated CT angiography panel. (A) Pre-interventional image, Kommerell's diverticulum and aberrant left subclavian with critical stenosis and poststenotic saccular aneurysm (white arrowhead). (B) Post-interventional image, complete exclusion and thrombosis of Kommerell's diverticulum and poststenotic aneurysm (white arrowhead). (C) Branched thoracic endograft (Castor, MicroPort ), correct alignment without endoleaks or thrombotic complications. (D) Maximum intensity projection (MIP) image showing supra-aortic vessel permeability. From left to right as seen in the image; right subclavian artery, right carotid artery, left carotid artery, extra anatomical bypass from the left carotid to left subclavian artery (white arrowhead), and native left subclavian artery excluded with an Amplatzer Vascular Plug II device.
case_images: fcvm-10-1309839-g003.jpg
case_images: PMC10754508_01_fcvm-10-1309839-g003.jpg
case_images: F3
case_images: The left arm claudication disappeared and a control ECG-gated CT angiography was performed 1 month after the intervention, which showed the complete thrombosis of the Kommerell's diverticulum and the post-stenotic aneurysm, the perfusion of all the supra-aortic branches was correct, and the endograft was well positioned without endoleaks or thrombotic complications (Figure 3).