Hybrid repair of Kommerell diverticulum with a right aortic arch and an aberrant subclavian artery: Debranching strategy based on Aortic arch configuration

Kommerell diverticulum (KD) is a rare aortic arch anomaly associated with an aberrant subclavian artery and can cause aneurysmal degeneration or compressive symptoms. Hybrid repair with thoracic endovascular aortic repair (TEVAR) has emerged as a less invasive alternative to open surgery; nonetheless, complex arch anatomy often limits achievement of a secure proximal landing zone. Two cases of KD with a right aortic arch and an aberrant left subclavian artery were treated with an anatomy-based hybrid repair. In both cases, intervention was indicated by diverticular size and the distance to the opposite aortic wall. Preoperative centerline analysis demonstrated severe aortic arch angulation in both patients. In Case 1, the proximal landing zone permitted stent graft deployment to the right common carotid artery with limited debranching, whereas in Case 2, greater arch angulation necessitated proximal extension with a more extensive debranching strategy. TEVAR was completed successfully in both cases, with complete diverticulum exclusion. Postoperative computed tomography confirmed patent bypass grafts, and both patients were discharged without complications. These cases support preoperative assessment of arch angulation to guide a hybrid repair strategy for KD.