To summarize the endovascular procedures of Kommerell diverticulum (KD) with or without aberrant left subclavian artery (LSA) in right-sided aortic arch.

From May 2013 to April 2019, 4 patients receiving endovascular treatments for the KD in right-sided aortic arch, with or without an aberrant LSA were retrospectively analyzed.

The four patients all underwent endovascular aortic repair. The first patient received Amplatzer vascular plug embolization of the aberrant LSA and endovascular repair of the KD, with a 0.035-inch, 260-cm stiff wire intentionally placed into the right subclavian artery (RSA) as a radiopaque marker delineating the proximal extent of the landing zone. The second one underwent endovascular aortic repair with a stent-graft implantation, embolization of the aberrant LSA and KD, and preservation of the RSA with chimney technique. The third patient underwent endovascular repair and the LSA, RSA and right carotid artery were preserved with chimney technique. Type Ia endoleak was found during the operation in this patient, and was treated with a stent graft implantation. The last patient who had right aortic arch with KD, without an aberrant LSA received endovascular repair without reconstruction of the LSA. There were no death, left arm ischemia, or neurological deterioration in all patients.

Endovascular treatment yields a relatively satisfactory outcome in patients of right-sided aortic arch with KD, with or without an aberrant LSA. The choice for each strategy should be based on the patients’ individual anatomy and pathological features.

Endovascular aortic repair; Right-side aortic arch; Kommerell diverticulum; Prognosis