Abstract
A 79-year-old man with a right-sided aortic arch was found to have progressive enlargement of an aberrant left subclavian artery aneurysm arising from a Kommerell diverticulum and associated with high-grade ostial narrowing on computed tomography angiography. Serial imaging demonstrated growth from 2.4 to 4.1 cm over 12 years. The patient underwent hybrid repair with left carotid-subclavian bypass, proximal subclavian occlusion, and thoracic endovascular aortic repair. Completion angiography demonstrated successful exclusion of the diverticulum and aneurysm without endoleak. Two-year surveillance imaging confirmed durable aneurysm exclusion, bypass patency, and absence of endoleak. This case highlights the feasibility and durability of hybrid repair for Kommerell diverticulum associated with severe aberrant left subclavian artery stenosis and poststenotic aneurysmal degeneration.