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Case Reports
. 2019 Mar 17:2019:7927613.
doi: 10.1155/2019/7927613. eCollection 2019.

Three Rare Structural Anomalies: Right Aberrant Subclavian Artery, Kommerell's Diverticulum, and Isolated Left Vertebral Artery All Associated with Type B Aortic Dissection

Yasser Farag Elghoneimy  1 , Medhat Reda Nashy  1 , Ahmed Elsayed Mahmoud  1 , Asayel Ali Alruwaili  1 , Assayl Rabea Alotaibi  1
Affiliations
Case Reports

Three Rare Structural Anomalies: Right Aberrant Subclavian Artery, Kommerell's Diverticulum, and Isolated Left Vertebral Artery All Associated with Type B Aortic Dissection

Yasser Farag Elghoneimy et al. Case Rep Surg. .

Abstract

Introduction and background: Right aberrant subclavian artery accounts for 0.5-1.8% of the population as the most frequently encountered aortic arch anomaly, while the prevalence of an isolated left vertebral artery ranges from 3 to 8%. Despite the low prevalence and the asymptomatic presentation of these structural anomalies, the development of cardiovascular complications and aneurysmal formation could happen as in Kommerell's diverticulum in a complicated right aberrant subclavian artery, which can undergo aneurysmal degeneration and dissection. Depending on the severity and the degree of the symptoms, the management of the patient can be determined.

Case presentation: A 51-year-old male hypertensive Pakistani patient was admitted complaining of chest and back pain; a CT of the aorta was done and showed type B aortic dissection associated with a right aberrant subclavian artery with an isolated left vertebral artery. A thoracic endovascular aneurysmal repair was done, and the patient improved afterward.

Conclusion: The prevalence of these structural anomalies, the right aberrant subclavian artery, Kommerell's diverticulum, and isolated left vertebral artery with type B aortic dissection, is uncommon. Therefore, the earlier the diagnosis, the better the treatment. This is the first case report explaining the occurrence of these vascular anomalies together in Saudi Arabia.

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Figures

Figure 1
Figure 1
Preoperative chest CT showing type B aortic dissection from the origin of the left subclavian artery.
Figure 2
Figure 2
Preoperative virtual 3D CT angiogram of the aorta showing the separate origin of the left vertebral artery from the aortic arch.
Figure 3
Figure 3
Intraoperative angiogram after stent placement.
Figure 4
Figure 4
Postoperative axial CT angiography.
Figure 5
Figure 5
Postoperative CT aorta 3D reconstruction posterior view showing Kommerell's diverticulum (1), patent right aberrant subclavian artery (2), left subclavian artery (3), and a stent inside the descending aorta (4).
See this image and copyright information in PMC

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