Surgical Treatment for Kommerell’s Diverticulum Associated with a Right-Sided Aortic Arch and an Aberrant Left Subclavian Artery: Endovascular or Hybrid

Abstract

A right-sided aortic arch, associated with an aberrant left subclavian artery and a Kommerell’s diverticulum, is a rare congenital anomaly. Case 1: A 53-year-old man, complaining of dysphasia, underwent a two-stage hybrid operation. Total arch replacement with the reconstruction of supra-aortic vessels was performed via a median sternotomy. Thoracic endovascular aortic repair was subsequently completed with the femoral approach. Case 2: A 81-year-old man, complaining of syncope and dizziness, underwent thoracic endovascular aortic repair after endovascular aneurysm repair for a common iliac artery aneurysm. Treatment strategies for Kommerell’s diverticulum should be individually determined depending on the clinical situation and anatomical features.

A Rare, Relapsing Kommerell Diverticulum – A Case Report

“…Surgical approach should be determined by the anatomic features of the KD, clinical presentation, comorbidities, past medical history and hemodynamic state to ensure an optimal treatment. Treatment must address the aneurysm as well as revascularization of the upper extremity [14].…”

Kommerell’s diverticulum with right-sided aortic arch and anomalous origin of neck vessels: Uncommon imaging finding in neonate with cyanosis

“… 4 The left ligamentum arteriosum (LLA) joins the root of aberrant left subclavian artery (ALSA) to the left pulmonary artery (LPA). 5 This along with RAA forms a vascular ring and typically seen with normal intracardiac anatomy. 6,7 Our case was type II with significant stenosis at the origin of ALSA and aberrant origin of neck vessels from RAA.…”

Emergent hybrid surgical approaches for non-dissecting ruptured Kommerell's aneurysm: a case report series

“…The only significant difference was in the group of patients that underwent endovascular interventions, showing a higher number of re-interventions, mainly due to the appearance of endoleaks (11.6%) [30]. Each approach will be discussed in more detail in the following paragraphs, and their advantages and disadvantages are summarised in Table 3 [23,27,28,[30][31][32][33][34][35][36].…”

“…However, in centres with adequate experience and resources available, a total endovascular approach could be considered for select emergent cases, such as patients with contained rKA or those at high risk of surgical complications., However, its major role is in preventing rupture or dissection of KA. A proximal anterograde chimney technique with a retrograde approach to improving the proximal seal and a concomitant periscope technique should be performed to maintain the AScA patency [35,36].…”