Aberrant right subclavian artery (ARSA) with Kommerell’s diverticulum (KD) is a rare but clinically significant aortic arch anomaly. Symptomatic or aneurysmal KD carries risks of compression and rupture. Hybrid repair combining surgical revascularization with thoracic endovascular aortic repair (TEVAR) has reduced morbidity; however, conventional TEVAR often requires left subclavian artery (LSA) coverage and additional bypass. The thoracic branch endoprosthesis (TBE) allows preservation of LSA perfusion during zone 2 TEVAR. A 41-year-old woman presented with chest pain and exertional dyspnea. Computed tomography angiography demonstrated an aberrant right subclavian artery with a 20-mm Kommerell’s diverticulum compressing the esophagus. Given symptoms and planned pregnancy, intervention was recommended. A staged hybrid approach was performed, consisting of right carotid–subclavian transposition followed by zone 2 TEVAR using a Gore Thoracic Branch Endoprosthesis, achieving exclusion of the diverticulum while preserving LSA flow. Completion angiography confirmed patency of all supra-aortic branches and complete exclusion of the diverticulum without endoleak. The patient had an uncomplicated recovery and was discharged on postoperative day 3. Follow-up imaging demonstrated durable exclusion and branch patency. The patient subsequently achieved an uncomplicated pregnancy and remains clinically well. This case demonstrates the feasibility of using a thoracic branch endoprosthesis as part of a hybrid repair for Kommerell’s diverticulum associated with ARSA. Preservation of LSA perfusion simplified the procedure and avoided additional surgical bypass. Branched thoracic endografting represents a promising minimally invasive option for selected patients with complex arch anatomy.
Rosenthal et al. (Sat,) studied this question.