Endovascular repair of the right arch and right descending with Kommerell diverticulum: a case report

Kommerell diverticulum is a developmental error with a remnant of fourth dorsal aortic arch, named after Dr. Kommerell, a radiologist, who made the first diagnosis in a living individual. It is a segmental aortic aneurysmal dilatation associated with aberrant subclavian arteries (ASAs) and can occur on either the left or the right side. Due to the rarity of this condition and underreporting in the literature, the clinical implications of a Kommerell diverticulum are not well defined. A 73-year-old female presented with shortness of breath for two months. Preoperative assessment via computed tomography angiography (CTA) revealed the following findings: (1) The aorta exhibited a right arch configuration with a right descending type, accompanied by the formation of a Kommerell diverticulum. The left subclavian artery and left common carotid artery shared a common trunk, while the right subclavian artery and right common carotid artery originated independently from the aortic arch. Additionally, the superior vena cava was shifted to the right, resulting in significant compression and narrowing of the left brachiocephalic vein trunk, along with displacement and distortion of the azygos vein. (2) Mild sclerosis of the abdominal aorta was noted. Transcatheter aortic repair (TEVAR) was performed to address the Kommerell diverticulum, and the patient demonstrated a satisfactory recovery following the surgical intervention. Kommerell diverticulum is a remnant of the dorsal aortic arch and can present in both left and right aortic arch configurations. Given the relatively high incidence of aortic events and the potential for degenerative changes in the diverticulum wall, it may be prudent to consider early surgical intervention for Kommerell’s diverticulum at a lower threshold size compared to that typically used for standard thoracic aortic aneurysms. Treatment strategies for Kommerell’s diverticulum should be individualized based on the specific anatomical features, the patient’s comorbidities, and the available surgical expertise.