The lusoria artery is the most frequent malformation of the aortic arch but remains rare with a prevalence of 0.5-2.5%. In the majority of situations, it remains asymptomatic but can lead to dysphagia lusoria or to aneurysmal degeneration, named Kommerell’s diverticulum. Due to the paucity of data, the ideal management as well as the indications to treat remain matter of debate. The aim of this study was to report our monocentric experience with the surgical management of this rare disease.

Retrospective analysis of prospective data retrieved from 1 center between February 2020 and January 2022 was done. Endpoints were technical success, postoperative morbidity, rate of endoleak and any aneurysm-related re-interventions during follow-up.

In this study, 4 patients with a median age of 70 years (range 44-78) were identified. There were 2 women and 2 men. Indications to treat were presence of Kommerell’s diverticulum in 3 cases and dysphagia lusoria in 1 case. The mean aneurysmal diameter was 35 mm (range 30-43). In 2 cases, the patients benefited from a 2-steps approach with left subclavian debranching followed by right sublclavian debranching and endovascular exclusion of the aneurysm, landing in zone 2. The mean length of the cTAG stentgrafts (Gore, Arizona, USA) was 125 mm. In 1 case, a custom-made extra-design stentgraft (Jotec, Hechingen, Germany) was created with a retrograde inner branch. In the case of a young woman (44 years old) with the dysphagia, an open approach was done with a sternotomy, aneurysmal resection and reimplantation of the right subclavian artery to the ascending aorta using a Dacron graft. There was 1 complication in the post-operative time with an occlusion o the inner branch to the aberrant right subclavian artery. A successful thrombectomy was performed with additional stenting. The mean length of stay was 5 days. During the mean follow-up of 9 months, no complications occurred but an asymptomatic reocclusion if the inner branch. 1 type II endoleak was observed but with stability of the aneurysmal sac.

Due to the lack of data, no guidelines exist regarding the management of lusoria artery. Both open and endovascular approaches seem to be safe and valid options. Due its aberrant nature and frailty, it seems better to avoid any stents in the lusoria artery and debranching with total exclusion should be preferred.