Hybrid and endovascular repair of aberrant subclavian artery aneurysms and Kommerell diverticulum: single-center experience and long-term outcomes

BACKGROUND: Aberrant subclavian artery (ASA) represents the most frequent congenital anomaly of the aortic arch and may occasionally develop aneurysmal dilation (aASA) at risk of dissection or rupture. Early diagnosis and tailored management are therefore crucial. We report our long-term single-center experience with endovascular and hybrid repair of aASA and Kommerell's diverticulum (KD). METHODS: We retrospectively analyzed all consecutive patients treated for aASA between January 2010 and June 2024 at our tertiary referral center. Primary endpoints were primary technical success, perioperative and late mortality, and major adverse cardiovascular events (MACE). Secondary endpoints included symptom evolution, reinterventions, and complications. RESULTS: Ten patients (5 females, 50%; mean age 62±19 years, range 16-80) were included. Seven (70%) presented with right ASA, and two (20%) with right aortic arch and left ASA. Seven patients (70%) were symptomatic; 43% had acute type B aortic dissection, 14% type A, and 28% descending thoracic aortic aneurysm. Four patients (40%) underwent total endovascular repair, and four (40%) hybrid procedures. Primary technical success was achieved in all cases, with no intraoperative deaths. Perioperative mortality was 10% and late mortality 30%. Complications included type II endoleak, access-site hematoma or infection, and transient upper-limb ischemia. No MACE occurred during the study period. CONCLUSIONS: Hybrid and endovascular approaches appear to represent safe and effective alternatives to open repair for complex aASA anatomy when performed in experienced referral centers. Given the limited cohort size, these findings should be interpreted as descriptive and hypothesis-generating.