Search

Abstract Background Double aortic arch (DAA) is a type of vascular ring, causing stridor and dysphagia owing to compression of the trachea and esophagus. In contrast, double innominate veins, which is a relatively rare venous anomaly, usually does not cause symptoms or require intervention. Case presentation A 2 month-old boy presented with mild stridor and a hoarse voice while crying, and was diagnosed as having DAA, small atrial septal defects and double innominate vein. The double innominate veins, crossing over and underneath the ascending aorta, did not contribute to airway compression. To release the narrow vascular ring caused by the DAA, surgical resection of the atretic side of the arch was performed by lateral thoracostomy at 4 months of age, before the appearance of signs of bronchomalacia. The double innominate veins were left untouched, and open-heart surgery was avoided. Conclusions DAA should be suspected if airway symptoms are present in early infancy, particularly if a right aortic arch is noted. It is important not to hesitate to perform diagnostic imaging and release the DAA, as this might prevent or minimize airway complications. However, for double innominate veins, operative release is not necessary unless it interferes with surgical procedures or is causing symptoms.

Right-sided aortic arch, first documented by Fioratti and Aglietti in 1763, is a rare variant of the thoracic vascular anatomy present in about 0.1% of the adult population. In half of these cases the left subclavian artery is also aberrant. The aberrant left subclavian artery usually originates from a conical dilatation near its origin from the aorta also known as “Kommerell's diverticulum.” Fewer than 80 of these cases have been reported in the literature as far as our web search is concerned. It is usually asymptomatic and diagnosed incidentally during adulthood. We are presenting a 56 years old male patient presented with right side chest and shoulder pain of 1 week duration. The pain exacerbated with motion of the right upper extremity and radiates to his lower back. However, he had no history of cough, shortness of breath, syncope, and dysphagia. The vital signs were in normal range. Pulmonary and cardiovascular exam were unremarkable. The complete blood count (CBC), electrocardiogram (EKG), and echocardiography showed no abnormality. In the adult population a right-sided aortic arch with an aberrant left subclavian artery arising from Kommerell's diverticulum is a rare occurrence often asymptomatic unless aneurysmal disease or compression of mediastinal structures ensues. Even though it is rare and at times an incidental finding, the condition is clinically relevant because of the morbidity caused by the complications. We report a case of Kommerell's Diverticulum of an aberrant left subclavian artery in an adult patient with a right-sided aortic arch. Right-sided aortic arch with aberrant left subclavian artery arising from Kommerell's Diverticulum is quite rare and may remain asymptomatic. On times it may cause symptoms in adulthood often as a result of early atherosclerotic changes of the anomalous vessels, dissection, or aneurysmal dilatation with compression of adjacent structures causing dysphagia, dyspnea, cough, or chest pain. Even though there are no general guidelines for the management of this condition patients need to be informed about the nature and possible outcomes of their condition. Close follow up of asymptomatic patients is one option of management until there are situations which require consideration of surgical intervention.

Background: Double aortic arch (DAA) is a type of vascular ring, causing stridor and dysphagia owing to compression of the trachea and esophagus. In contrast, double innominate veins, which is a relatively rare venous anomaly, usually does not cause symptoms or require intervention. Case presentation: A 2 month-old boy presented with mild stridor and a hoarse voice while crying, and was diagnosed as having DAA, small atrial septal defects and double innominate vein. The double innominate veins, crossing over and underneath the ascending aorta, did not contribute to airway compression. To release the narrow vascular ring caused by the DAA, surgical resection of the atretic side of the arch was performed by lateral thoracostomy at 4 months of age, before the appearance of signs of bronchomalacia. The double innominate veins were left untouched, and open-heart surgery was avoided. Conclusions: DAA should be suspected if airway symptoms are present in early infancy, particularly if a right aortic arch is noted. It is important not to hesitate to perform diagnostic imaging and release the DAA, as this might prevent or minimize airway complications. However, for double innominate veins, operative release is not necessary unless it interferes with surgical procedures or is causing symptoms. [ABSTRACT FROM AUTHOR]

Few studies describe outcomes after complete vascular ring surgery in a comprehensive manner. This study sought to describe the clinical presentation, diagnostic work-up, operative approach, and outcomes in children undergoing surgery for complete vascular rings. This single-center retrospective cohort study includes consecutive patients (January 1990 through September 2023) undergoing primary surgery for complete vascular rings, or rerepair after primary surgery elsewhere. The primary outcome of interest was complete (as distinct from partial) symptom resolution at latest clinic follow-up. Our current preference is to pursue a comprehensive initial operation including adjunctive vascular and airway procedures targeting common causes of residual aerodigestive symptoms, such as Kommerell diverticulum resection and tracheobronchopexy. Preoperative work-up routinely involved computed tomographic angiography, dynamic bronchoscopy, and laryngoscopy. Of 515 patients (including 39 rerepairs), the most common diagnoses were right aortic arch with aberrant left subclavian artery and left ligamentum arteriosum (n = 323, 62.7%) and double aortic arch (n = 174, 33.8%). There was no perioperative mortality. Chylothorax occurred in 28 patients (5.4%), vocal cord dysfunction in 22 patients (4.3%), and diaphragm paralysis in 2 patients (0.4%). Follow-up was available on 453 patients (88.0%) with a median duration of 3.0 years (Q1-Q3: 0.6-9.2 years). At latest clinic follow-up, 429 patients (94.7%) reported complete symptom resolution. The risk of reoperation for residual or recurrent aerodigestive symptoms was 9.6% (95% CI: 5.7%-13.5%) at 10 years and 12.4% at 20 years (95% CI: 6.9%-17.8%). Surgery for complete vascular rings provides good symptomatic relief with low risk of complications, whereas reoperations for aerodigestive symptoms are infrequent. [ABSTRACT FROM AUTHOR]

Vascular rings are a rare congenital anomaly of the aortic arch, in which a ring-shaped structure forms, surrounding the trachea and/or esophagus, potentially causing compression. We describe the case of a 14-month-old female patient with failure to thrive secondary to dysphagia, and a vascular ring formed by a right aortic arch, an aberrant left subclavian artery, and a left ligamentum arteriosum. Surgical repair involved ligamentum arteriosum division, Kommerell's diverticulum obliteration, and left subclavian artery re-implantation into the left carotid artery. Endoscopy and EndoFLIPTM evaluated the intraoperative improvement in esophageal narrowing and impedance, respectively. The postoperative period was uneventful, and follow-up visits demonstrated dysphagia resolution and a patent re-implanted left subclavian artery. [ABSTRACT FROM AUTHOR]

Kommerell's diverticulum is a rare congenital anomaly of the aortic arch system in which there is a left- or right-sided aortic arch with an aberrant subclavian artery on the contralateral side. Patients with this anomaly can be asymptomatic or have features of tracheal or oesophageal compression. However, there is a rising suspicion that it may be a rare cause of unilateral vocal cord palsy through its compression of the recurrent laryngeal nerve. We describe a patient who had a long history of hoarse voice and left vocal cord palsy with no other obvious cause, who was found to have a Kommerell's diverticulum on a contrast-enhanced computed tomography scan. [ABSTRACT FROM AUTHOR]

A Kommerell's diverticulum (KD) is a saccular aneurysmal outpouching at the origin of an aberrant subclavian artery. Due to a lack of data in the literature, there are no standardized guidelines for management of KD, and the diverse presentation of associated aberrant anatomy complicates evaluating the best modality of treatment. We present a 74-year-old woman who had a uniquely aberrant aortic arch with an aberrant retroesophageal right subclavian artery associated with a KD and a saccular aneurysm off the left subclavian artery who was treated via a hybrid approach, demonstrating the feasibility of this treatment modality in a patient with unique aberrant arch anatomy. KEY POINTS: Kommerell's diverticulum (KD) is a rare congenital anomaly, and whether one should treat KD is controversial. Especially unique aberrant arch anatomy presents a technical challenge for treatment amidst the concomitant lack of consensus on intervention for KD treatment. In this case report, successful repair of KD with unique aberrant arch anatomy was done in a hybrid staged fashion with extrathoracic revascularization followed by thoracic endovascular aortic repair. [ABSTRACT FROM AUTHOR]

The management of Kommerell's Diverticulum (KD) has been evolving from open repair to a hybrid of open and endovascular repair. While there is no consensus regarding the optimal strategy, the need for less invasive treatment with less morbidity early recovery, and improved quality of life is a common goal for both the patient and the provider. [ABSTRACT FROM AUTHOR]

We present a rare anatomical configuration of a 19-year-old woman, characterized by descending thoracic aortic aneurysm with right aberrant subclavian arteries with a Kommerell's diverticulum in a left aortic arch. The complexity of this vascular anomaly was accompanied by an anomalous origin of left subclavian artery. The patient underwent a single-stage open surgical repair via left thoracotomy under deep hypothermic circulatory arrest. The bilateral aberrant subclavian arteries were separately reconstructed in situ using hand-sewn branched grafts.

Abstract Background Kommerell’s diverticulum with a right-sided aortic arch and aberrant left subclavian artery is uncommon. We perforemed a single-stage procedure with the frozen elephant trunk technique. Case presentation A 62-year-old man underwent aortic dissection a year ago, and computerized tomographic angiography performed at that time revealed a right aortic arch, Kommerell’s diverticulum (42 mm), and an aberrant left subclavian artery. We performed one-stage repair through median sternotomy. The cervical branches were exposed during the operation, and a deep hypothermic circulatory arrest with antegrade cerebral perfusion was established. The aorta was transected distally to the origin of the left carotid artery. We inserted a stent graft into the aorta, followed by peripheral anastomosis using a premade 5-branch Dacron graft. The right subclavian artery and the aorta were reconstructed, and the remaining cervical branches were reconstructed after the cross-clamp had been released. Conclusions Total arch replacement through median sternotomy was performed for the right aortic arch, Kommerell’s diverticulum, and aberrant left subclavian artery. The frozen elephant trunk technique is allowed to perform a one-stage operation safely.

The combination of the right aortic arch and aberrant left subclavian artery (ALSA) with Kommerell's diverticulum (KD) is rare to coexist with the left innominate vein (LINV) beneath the aortic arch. It escalates the surgical risk undoubtedly and increases the difficulty of clinical procedures. We report one case diagnosed by Ultrasound and Computed Tomography Angiography (CTA). [ABSTRACT FROM AUTHOR]

Vascular rings are a rare congenital anomaly of the aortic arch, in which a ring-shaped structure forms, surrounding the trachea and/or esophagus, potentially causing compression. We describe the case of a 14-month-old female patient with failure to thrive secondary to dysphagia, and a vascular ring formed by a right aortic arch, an aberrant left subclavian artery, and a left ligamentum arteriosum. Surgical repair involved ligamentum arteriosum division, Kommerell’s diverticulum obliteration, and left subclavian artery re-implantation into the left carotid artery. Endoscopy and EndoFLIPTM evaluated the intraoperative improvement in esophageal narrowing and impedance, respectively. The postoperative period was uneventful, and follow-up visits demonstrated dysphagia resolution and a patent re-implanted left subclavian artery.

Background: Kommerell's diverticulum with a right-sided aortic arch and aberrant left subclavian artery is uncommon. We perforemed a single-stage procedure with the frozen elephant trunk technique. Case presentation: A 62-year-old man underwent aortic dissection a year ago, and computerized tomographic angiography performed at that time revealed a right aortic arch, Kommerell's diverticulum (42 mm), and an aberrant left subclavian artery. We performed one-stage repair through median sternotomy. The cervical branches were exposed during the operation, and a deep hypothermic circulatory arrest with antegrade cerebral perfusion was established. The aorta was transected distally to the origin of the left carotid artery. We inserted a stent graft into the aorta, followed by peripheral anastomosis using a premade 5-branch Dacron graft. The right subclavian artery and the aorta were reconstructed, and the remaining cervical branches were reconstructed after the cross-clamp had been released. Conclusions: Total arch replacement through median sternotomy was performed for the right aortic arch, Kommerell's diverticulum, and aberrant left subclavian artery. The frozen elephant trunk technique is allowed to perform a one-stage operation safely. [ABSTRACT FROM AUTHOR]

Background: Kommerell's diverticulum (KD) with a right aortic arch (RAA) and aberrant left subclavian artery (aLSCA) is a rare congenital anomaly of the aortic arch. Treatment is not well defined due to its uncommon presentation, with rupture and dissection risk rates of up to 53%. Case summary: A 54-year-old male with a history of chronic obstructive pulmonary disease (COPD) and hypertension presented with difficulty breathing during exercise without dysphagia. Follow-up computerized tomography angiogram (CTA) revealed the presence of a RAA and aLSCA arising from the descending thoracic aorta with an adjacent 58 × 41-mm KD and tracheal and esophageal displacement. Due to the size of the KD, risk of rupture, unsuitable anatomy for total endovascular aortic repair (EVAR), and high COPD burden, the patient was planned to undergo a hybrid surgical repair. Left common carotid (LCCA) artery to LSCA bypass, full aortic debranching, LSCA embolization and percutaneous thoracic endovascular aortic repair (TEVAR) were performed. Successful device position and exclusion of the diverticulum and aneurysmal aorta were observed after completion thoracic aortogram. 18-month follow-up CTA demonstrated patency of the LSCA to LCCA bypass graft and arch vessel branches, as well as stable exclusion of the KD. Persistence of a type II endoleak originated at the right first posterior intercostal artery has been noted and is being followed conservatively since no sac growth has occurred. Conclusion: We highlight the presence of a KD with RAA and aberrant subclavian artery, a rare congenital anatomic variation of the aortic arch with complex anatomy. Surgical planning must be individualized according to comorbidities and anatomical variations identified on imaging and 3D reconstructions. [ABSTRACT FROM AUTHOR]

This article discusses a case report of a patient with a right aortic arch who underwent thyroid surgery. The patient had a history of aortic arch malformations and presented with a thyroid tumor. Preoperative imaging and continuous intraoperative nerve monitoring were used to determine the course of the recurrent inferior laryngeal nerve (RILN) and ensure safe surgery. The left inferior laryngeal nerve was confirmed to be the RILN, and the surgery was successful without complications. The article emphasizes the importance of special attention and monitoring in patients with aortic arch malformations during thyroid surgery. [Extracted from the article]

Kommerell's diverticulum in association with left or right aberrant subclavian arteries is a rare finding and is challenging to treat. Contemporary surgical and endovascular techniques provide a broad arsenal of possible treatments. Imaging techniques and modeling technology allow a more personalized strategy for each patient. In this case, we present a symptomatic patient with a Kommerell's diverticulum and a left aberrant subclavian artery complicated by proximal stenosis and poststenotic aneurysm. A hybrid technique using a single-branched thoracic stent-graft (Castor, MicroPort Medical, Shanghai, China) in combination with a surgical left subclavian-carotid bypass and endovascular occlusion of the poststenotic aneurysm using a vascular plug device (Amplatzer Vascular Plug, Abbott, Chicago, United States) was performed. This approach was planned and facilitated by the use of a 3D model. Alternative treatment options and the strengths of this approach are briefly reviewed and discussed.

Introduction: The management of Kommerell's Diverticulum (KD) has evolved from open surgical resection and graft replacement of the aorta, to endovascular repair in asymptomatic patients due to its recognized possible sequelae – aortic rupture and dissection. Despite these technical advances, standard indications for intervention and treatment algorithms remain unclear. We will present our single-center experience in the treatment of KD, supporting a multidisciplinary endovascular-first approach. Methods: All patients who underwent thoracic endovascular aortic repair (TEVAR) for KD between 2017 and 2020 were retrospectively identified from a prospectively maintained institutional surgery database. Chart review was used to characterize presenting symptoms, interventions, technical results, and complications. Revascularization was performed using carotid-axillary bypass. Routine endovascular subclavian artery occlusion was employed to eliminate retrograde diverticulum perfusion and avoid open ligation. Results: 8 patients were identified, including 6 females and 2 males between the ages of 44-76. Patients presented with dysphagia (n = 3), acute embolic stroke (n = 1), transient ischemic attack (TIA) (n = 1), upper extremity embolization (n = 1), and acute type B aortic dissection (n = 1). One patient had a prior incomplete open repair that was successfully treated endovascularly. Another patient had a mediastinal neoplasm infiltrating an incidental aberrant subclavian artery and KD. All cases had symptomatic improvement and successful endovascular repair as demonstrated on post-operative imaging. Perioperative complications included percutaneous access site pseudoaneurysm (n = 2), stroke (n = 1), and subclavian artery rupture immediately recognized and treated (n = 1). There was no perioperative mortality. Conclusion: Endovascular techniques have resulted in technical success and symptomatic improvement for KD without open thoracotomy or sternotomy. Significant rates of endovascular complications and paucity of long-term durability data should be considered. Until formal criteria for repair are established, early application of TEVAR using a consistent multi-specialty approach may mitigate the risk of unpredictable aortic complications in these patients while avoiding the accepted morbidity and mortality of open surgery. [ABSTRACT FROM AUTHOR]

Atrophy of the fourth right aortic arch during embryogenesis can lead to arteria lusoria. This occurs with a frequency of 0.5-2%. This artery originates directly from the aortic arch as a fourth branch or from the proximal part of the descending aorta. Then it follows an upward and rightward direction crossing the trachea and esophagus in its course. This abnormal artery is accompanied in 20-60% of cases by dilatation of its proximal part, called Kommerell's diverticulum. A correlation has been noted between the presence of arteria lusoria and chromosomal aberrations, mainly Down syndrome. Arteria lusoria in fetuses is diagnosed using ultrasound, and in adults, the gold diagnostic standard is computed tomography or magnetic resonance angiography. Consequences of arteria lusoria may include dysphagia (dysphagia lusoria), chronic cough, arteriooesophageal fistula, retrosternal pain, respiratory problems, and numbness of the right upper limb. Respiratory disorders accompanying arteria lusoria occur mainly in children because their trachea is less rigid than in adults and more prone to deformation. Arteria lusoria is a clinically significant marker of fetal congenital malformations. It also may be a cause of nonspecific symptoms in children and adults that should be considered during differential diagnosis. [ABSTRACT FROM AUTHOR]

Right aortic arch is caused by a malformation of the aorta while Kommerell's diverticulum is a saccular aneurysm arising at the origin of the subclavian artery. Both diseases are caused by malformations during embryonic development and can subsequently cause compression of the esophagus and trachea due to abnormal arterial migration. Here, we report five cases of esophageal stenosis due to aortic angiogenesis anomalies. Three of the five cases had aortic running abnormalities, noted on computed tomography (CT). However, until it was observed for the first time, esophageal stricture was not recognized as an esophagogastroduodenoscopy (EGD) finding due to the lack of knowledge of diseases such as Kommerell's diverticulum even when EGD was performed during regular follow-up after treatment for esophageal cancer or other conditions. Symptoms include dysphagia and dyspnea due to stenosis of the esophagus and trachea, however, regardless of symptomatic presentation, the presence of esophageal stenosis on EGD should be considered as an effect of aortic travel abnormality or Kommerell's diverticulum. Although there have been no reports of Kommerell's diverticulum rupture due to endoscopic manipulation, gastroenterologists should consider the possibility of Kommerell's diverticulum during clinical decision making. [ABSTRACT FROM AUTHOR]

Central venous catheter placement continues to be an extremely common procedure throughout hospital systems. Although ultrasound guidance can mitigate some placement risks, misplacement of lines into neighboring structures, such as arteries, remains an unfortunate complication. In this report, we will discuss an 83-year-old female with aberrant left subclavian artery and right sided arch, which provided for successful stent graft coverage of arterial injury secondary to accidental subclavian artery cannulation with a central venous catheter with preservation of the right common carotid artery and avoidance of a potentially morbid sternotomy.

BackgroundUnilateral pulmonary artery agenesis (UPAA) and Kommerell's diverticulum (KD) are two rare embryologically unrelated congenital vascular malformations rarely diagnosed in children. This is the first report of our knowledge of the unique combination for a child as patients are at a high risk of pulmonary hypertension and rupture of the diverticulum. Our aim is to present the case of a pediatric patient with UPAA and KD with the short literature review and to highlight the importance of early diagnostics of rare congenital vascular malformations.Case reportA 1-year-old girl presented to the emergency department with prolonged cough and variable wheezing. A hypoplastic left lung was suspected in the radiographic image of the chest. A transthoracic echocardiogram revealed absence of the left pulmonary artery and right arch of aorta and anomaly of subclavian arteries was suspected. The diagnosis was confirmed by computed tomography scans of the chest that demonstrated elongation of the aorta and an aberrant right subclavian artery with KD, as well as absence of the left pulmonary artery. The patient is being followed up for the development of pulmonary hypertension and compression of vascular structures to the airways as well as any indications for surgical intervention because of the KD.ConclusionsUPAA and KD are two very rare congenital vascular anomalies usually diagnosed in adults. A high risk of pulmonary hypertension and rupture of diverticulum is noted for adult patients. This case provides us with an exclusive possibility to follow up a patient with an extremely rare combination of the two vascular anomalies with insufficiently known future complications and outcomes.

Background: Kommerell's diverticulum with Stanford type A aortic dissection is a relatively rare condition. There is currently no standard treatment strategy for Kommerell's diverticulum. We herein report our surgical strategy with a review of literature for a case of Kommerell's diverticulum that developed acute aortic dissection. Case presentation: A 54-year-old woman was referred to our hospital after being diagnosed with Stanford type A acute aortic dissection at the hospital where she was admitted for chest and back pain. Contrast-enhanced computed tomography showed a right and left common carotid and left subclavian artery branching from the aortic arch; Kommerell's diverticulum and an aberrant right subclavian artery (RSCA) arising from it were noted in the distal arch. The contralateral aortic wall where Kommerell's diverticulum was located was the entry, resulting in aortic dissection, with retrograde dissection extending into the ascending aorta. Partial thrombosis was detected in the false lumen of the ascending aorta. The dissection extended from the ascending aorta to the common iliac artery. In addition, the thrombosed false lumen in the left common iliac artery was considered to have caused dynamic obstruction due to compression and narrowing of the true lumen. Based on these findings, total arch replacement with reconstruction of the 4-branched vessels in the arch, including an aberrant RSCA, the frozen elephant trunk technique, and femoro-femoral bypass for malperfusion of the left lower extremity were performed with deep hypothermic circulatory arrest. An artificial graft was anastomosed to the right axillary artery, which was used as the blood supply route for cardiopulmonary bypass. After cooling to hypothermia, the central portion of the aberrant right subclavian artery was clipped on the right side of the trachea. Thus, cerebral blood flow was maintained via the right vertebral artery, the aortic arch was opened, and cannulas for selective cerebral perfusion were inserted into the right common carotid artery, the left common carotid artery, and the left subclavian artery. After each vessel was reconstructed, the graft that had been anastomosed to the right axillary artery was anastomosed to the graft used for reconstruction of the right common carotid artery. The patient's postoperative course was generally good. Conclusion: The strategy used by us effectively created transient occlusion of the origin of Kommerell's diverticulum and the primary entry. Our results indicate that this method is feasible and effective for cases in which in situ reconstruction of the branch may be challenging.

Objectives: The aberrant subclavian artery is among the congenital vascular anomalies of the aortic arch. Aberrant subclavian arteries can be seen in different types and on the right or left side. Aneurysmal dilatation, named Kommerell's diverticulum, may be seen in the descending thoracic aorta at the origin of the right aberrant subclavian artery. The aim of this study aimed to present our experience with aberrant subclavian artery pathology. Materials and Methods: This was a retrospective review of our experience from two instutitions with 14 patients who had an aberrant subclavian artery between 2015-2021. Seven patients (62.5%) were male, and the median age at the time of surgery was 38.4 months (range: 6 months to 75 years). Patients were either asymptomatic, incidentally diagnosed, or presented with dyspnea and/or dysphagia lusoria. Results: Asymptomatic patients were not interfered. There was no early or late mortality in 6 patients who underwent surgery. Three (50%) patients underwent aberrant right subclavian artery repair through right thoracotomy, two received a hybrid approach due to Kommerell's diverticulum, and one patient underwent aberrant left subclavian artery repair from left thoracotomy. The median postoperative duration of the intensive care unit and hospital stays were 1 and 6 days, respectively. Patients were followed for a median of 3.6 years (range, 1.2-6.8 years) after intervention. No endoleak was observed in the follow-up of patients who underwent endovascular repair. Conclusion: The data suggest that symptomatic aberrant subclavian artery pathology can be treated safely in selected patients with good early and mid-term results. The right or left side of the aberrant subclavian artery may change the surgical approach. Patients with Kommerell's diverticulum with a right aberrant subclavian artery can be treated with a hybrid approach using endovascular techniques. [ABSTRACT FROM AUTHOR]

Atrophy of the fourth right aortic arch during embryogenesis can lead to arteria lusoria. This occurs with a frequency of 0.5–2%. This artery originates directly from the aortic arch as a fourth branch or from the proximal part of the descending aorta. Then it follows an upward and rightward direction crossing the trachea and esophagus in its course. This abnormal artery is accompanied in 20–60% of cases by dilatation of its proximal part, called Kommerell’s diverticulum. A correlation has been noted between the presence of arteria lusoria and chromosomal aberrations, mainly Down syndrome. Arteria lusoria in fetuses is diagnosed using ultrasound, and in adults, the gold diagnostic standard is computed tomography or magnetic resonance angiography. Consequences of arteria lusoria may include dysphagia (dysphagia lusoria), chronic cough, arterio-oesophageal fistula, retrosternal pain, respiratory problems, and numbness of the right upper limb. Respiratory disorders accompanying arteria lusoria occur mainly in children because their trachea is less rigid than in adults and more prone to deformation. Arteria lusoria is a clinically significant marker of fetal congenital malformations. It also may be a cause of non-specific symptoms in children and adults that should be considered during differential diagnosis.

Kommerell's diverticulum (KD) is a rare congenital vascular abnormality due to the formation of an abnormal aortic arch, most commonly associated with dilatation at the proximal part of the aberrant subclavian artery. This article describes an option of surgical treatment in a patient with KD. The proposed new technique of aortic arch surgical reconstruction with a stent‐graft placement in the descending aorta reduces CPB time, aortic clamp and circulatory arrest time. [ABSTRACT FROM AUTHOR]

Aneurysm of the aberrant left subclavian artery arising from Kommerell's diverticulum is very rare. Early intervention is recommended in such a case to avoid complications. Rarely, such an aneurysm may present with a concomitant cardiac pathology. Surgical approach in this complex scenario is difficult as anatomically distant areas have to be exposed and usually a staged approach is preferred. There are only a few published reports about the same. We report, for the first time, successful single-stage intervention in a patient with aortic regurgitation, right aortic arch, and aneurysmal aberrant left subclavian artery from Kommerell's diverticulum, exclusively through median sternotomy. A 37-year-old gentleman presented with the complaints of palpitations (New York Heart Association grade II) and left-sided neck swelling of 4 months' duration. He also had history of hoarseness of voice for 2 weeks. He was diagnosed to have aortic regurgitation, right aortic arch, and aneurysmal aberrant left subclavian artery from Kommerell's diverticulum and was treated by single-stage repair of the aneurysm and aortic valve replacement with mechanical prosthesis via median sternotomy. Single-stage intervention through midline sternotomy provides excellent outcomes and can be a feasible option for such a complex aortic anomaly. [ABSTRACT FROM AUTHOR]

Hybrid single-stage repair of Kommerell's diverticulum in a right aortic arch. Aortic arch anomalies, isolated or associated with congenital heart defects, are cardiovascular manifestations frequently associated with 22q11.2 deletion syndrome. Kommerell's diverticulum in the context of a right aortic arch is an exceedingly rare congenital anomaly, consisting in aneurysmal degeneration of the origin of an aberrant left subclavian artery. Open surgical repair has been the treatment paradigm, but in recent years, hybrid and endovascular procedures have also been proposed. In this report we present the case of a patient affected by 22q11.2 deletion syndrome successfully treated for Kommerell's diverticulum associated with a right-sided aortic arch through a single-stage hybrid procedure, consisting of bilateral carotid-subclavian bypass, exclusion of the diverticulum by an endovascular thoracic stent graft, and aberrant left subclavian artery plug occlusion. This type of hybrid technique can be an excellent alternative to extensive open surgical repairs or when total endovascular repair is deemed unachievable, also in the context of a complex genetic syndrome. [ABSTRACT FROM AUTHOR]

Kommerell’s diverticulum (KD) is a rare aneurysm of the origin of an aberrant subclavian artery. Hybrid aortic arch repair for KD is being performed more often. We report hybrid arch repair for KD in a 63-year-old man with a right aortic arch and aberrant right vertebral artery, an extremely rare variant. We performed total arch replacement to completely reconstruct the five cervical arteries with elephant trunk to create an adequate landing zone, followed by second-stage endovascular stent-grafting from the ascending aorta to the proximal descending aorta.