Back to 2026 Abstracts
Staged Hybrid Repair Of An Aneurysmal Retroesophageal Aberrant Right Subclavian Artery Arising From Kommerell's Diverticulum
Vanessa Sauer, MS2, Dar Chung, MD, Eanas Yassa, MD.
Corewell Health, Grand Rapids, MI, USA.
DEMOGRAPHICS: The patient is a 68-year-old male with an aneurysmal aberrant right subclavian artery arising from a Kommerell’s diverticulum, and concomitant descending thoracic and pararenal abdominal aortic aneurysms.
HISTORY: The patient presented with progressive exertional dyspnea, dysphagia, odynophagia, chest pain, and left leg claudication. CT angiography incidentally revealed a rare constellation of vascular anomalies: a retroesophageal aneurysmal aberrant right subclavian artery arising from a Kommerell’s diverticulum, along with descending thoracic and pararenal abdominal aortic aneurysms. ARSA with KD is a rare congenital anomaly of the aortic arch, with a prevalence of 0.5-1% in the general population, and often detected on imaging performed for unrelated reasons.
PLAN: Given the anatomical complexity and symptoms suggesting esophageal and tracheal compression, a staged hybrid repair was planned. The first stage involved an end-to-side right carotid-subclavian bypass using an 8mm Gelsoft Dacron graft. The second stage, performed three days later, used a 34mm thoracic endovascular aortic graft to exclude the ARSA aneurysm and a thoracic branch endoprosthesis (TBE) into the left subclavian artery. This was complicated by graft migration that required proximal and distal extensions and a type IA endoleak that was resolved with further proximal balloon molding. The patient tolerated both procedures well and was discharged home in a stable condition on postoperative day three. Follow up imaging showed patent stent grafts, decreased aneurysm size, and no endoleak.
DISCUSSION: This case illustrates the rare but clinically significant presentation of a retroesophageal subclavian artery aneurysm in the setting of Kommerell’s diverticulum. It demonstrates the feasibility of a staged hybrid approach combining open cervical revascularization with advanced branched thoracic endovascular repair. This strategy achieves durable aneurysm exclusion while preserving cerebral and upper extremity perfusion.
Figure 1 Computed tomography angiogram reconstructions pre (A) and post (B,C) treatment. (A) ARSA extending posterior to the trachea and esophagus with fusiform bilobed aneurysm in the intrathoracic segment measuring up to 3.7 cm. (B) A stent remains in the arch and throughout the descending segment in stable position and appears widely patent. (C) Transection of the ARSA and anastomosis to the right common carotid artery.
Back to 2026 Abstracts
