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

Introduction: 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.

Case presentation: 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.

Conclusions: 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.