Thoracic Endovascular Aortic Repair for Kommerell’s Diverticulum

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Objectives: Thoracic endovascular aortic repair (TEVAR) has recently emerged as a less invasive alternative to open thoracotomy for the treatment of Kommerell’s diverticulum (KD). However, anatomical challenges, including an acute aortic arch and an aberrant subclavian artery, often limit its feasibility. This study aimed to evaluate the outcomes of TEVAR for KD.

Methods: Between February 2012 and July 2023, 6 patients with KD underwent TEVAR at 3 institutions. Subclavian artery embolization or reconstruction was performed when necessary. Morphological parameters, including the Kommerell’s diverticulum diameter (KDd) and the distance to the opposite aortic wall (DAW), were assessed.

Results: Four patients underwent subclavian artery embolization, including 1 requiring bilateral embolization. Subclavian artery reconstruction was performed in 2 cases. Intraoperative type 1a endoleaks were observed in 3 cases and were successfully managed with additional stent grafts. During a follow-up period ranging from 13 to 83 months, 1 patient required open surgical conversion due to graft infection. No other severe complications or aneurysmal progression were noted.

Conclusions: Despite the limited follow-up period and lack of long-term data, TEVAR for KD demonstrated favorable short- to mid-term outcomes and may represent an effective treatment option in selected patients.