Repair of Kommerell's Diverticulum and Aberrant Subclavian Arteries: Classification of the Five Groups in Declining Frequency and Their Operative Approaches

Aberrant subclavian arteries are a result of unusual involution of the branchial arches resulting in persistent arteries that can cause tracheal or esophageal compression. Many are incidental findings but may be associated with dysphagia (dysphagia lusus naturae, Latin for “jest of nature”), a long history of asthma treatment for wheezing, or more uncommonly, aneurysms or aortic dissection. There are 5 basic approaches for repair discussed herein, determined by which subclavian artery is involved and where the aortic arch and descending thoracic aorta lie, as well as the size of the latter, classified as Groups A to E, in order of frequency. These include: A: Aberrant RSCA and left arch; B: Aberrant LSCA and right arch; C: Aberrant RSCA, no significant Kommerell's and descending aneurysm; D: Aberrant LSCA and right-sided arch but compression from a vascular ring; and E: Aberrant RSCA and extensive arch and descending aneurysm.