# Optimal Surgical Strategy for Kommerell’s Diverticulum Associated with a Right-Sided Aortic Arch: A Report of Four Cases

## TL;DR

This paper presents four case studies to suggest optimal surgical approaches for Kommerell’s diverticulum in patients with a right-sided aortic arch.

## Contribution

The paper proposes a tailored surgical strategy based on anatomical and clinical factors for a rare anatomical condition.

## Key findings

- Surgical approaches should consider anatomical variations of the aortic arch and cervical vessels.
- Compression symptoms and surgical risks influence the choice of treatment modality.
- Open surgery and thoracic endovascular repair were both successfully used in different cases.

## Abstract

Kommerell’s diverticulum is often associated with a right-sided aortic arch. It presents as a saccular aneurysm. Although various surgical strategies have been reported, optimal treatment has not been established.

Four patients with right-sided aortic arch underwent different surgeries for Kommerell’s diverticulum. The pattern of aortic arch was a mirror-image of the normal left aortic arch in Cases 1 and 2. In Cases 3 and 4, it was right-sided aortic arch with an aberrant left subclavian artery as its last branch. Cases 1 and 3 presented with compression symptoms caused by Kommerell’s diverticulum. They underwent open surgery or thoracic endovascular aortic repair through the different approaches. Their postoperative courses were favorable.

The surgical strategy for Kommerell’s diverticulum with a right-sided aortic arch should be selected based on the anatomical characteristics of the cervical vessels, compression symptoms, and surgical risks.