Endovascular repair of ruptured aberrant left subclavian artery with right aortic arch

Association of a right-sided aortic arch with an aberrant left subclavian artery is rare. We present a case of successful endovascular repair of a ruptured Kommerell diverticulum associated with a right-sided aortic arch and aberrant left subclavian artery. We treated a 47-year-old woman with a diagnosis of ruptured aberrant left subclavian artery with thoracic endovascular stent-grafts. The descending aorta above Kommerell diverticulum was a reverse-tapered configuration. We managed the rather hostile neck with an extra-large Palmaz stent. A left carotid-to-subclavian bypass with an 8-mm Dacron graft was also performed to restore left arm perfusion and prevent vertebrobasilar insufficiency.