Hybrid management of aneurysmal vascular ring and a Kommerell's diverticulum in an adult: Case report

INTRODUCTION AND IMPORTANCE: Congenital vascular rings are rare in adults. The management is challenging when vascular rings present with concomitant aortic aneurysm and Kommerall's diverticulum. CASE PRESENTATION: We present a 68year old patient with a congenital vascular ring in the form of right sided aortic arch, with a retroesophageal left subclavian artery arising from an aneurysmal Kommerell's diverticulum. In addition, the patient had aneurysmal distal aortic arch and proximal descending aorta, causing severe symptomatic tracheal compression. The patient was successfully managed by debranching and reimplantation of head neck vessels to the ascending aorta through a median sternotomy, and concurrent endovascular stenting of the aneurysmal aorta. CLINICAL DISCUSSION: A combination of complete vascular rings and aortic arch aneurysm poses a potentially higher surgical risk. The use of the less invasive endovascular stenting of the aorta as well as a limited open surgical approach offers a lesser risk, especially in poor pre-operative states. CONCLUSION: A multidisciplinary team effort is key. Hybrid management of aneurysmal congenital vascular rings in high risk adults offers an attractive management alternative to conventional surgery.