title: Hybrid treatment of a ruptured diverticulum of Kommerell.
abstract: OBJECTIVE
  To report a patient with a ruptured diverticulum of Kommerell and to discuss treatment options and complications.
  
  
  METHODS
  An 82-year-old woman with no prior medical history was diagnosed with a ruptured aneurysmal proximal aberrant right subclavian artery (diverticulum of Kommerell). She was treated with a carotid-subclavian bypass, a thoracic aortic stent-graft covering both subclavian orifices, and a vascular plug in the proximal right subclavian artery. After an initially uneventful recovery, the patient developed delayed ischemic esophageal ulcerations and subsequent perforation at 6 weeks postoperatively, leading to mediastinitis and stent-graft infection.
  
  
  CONCLUSIONS
  A hybrid approach may be of value in cases of ruptured diverticulum of Kommerell. However, despite the anticipated reduction in perioperative mortality, this technique still yields a considerable risk of postoperative complications and mortality.
authors.affiliation: Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. janbosma@yahoo.com
authors.forename: Jan
authors.initials: J
authors.lastname: Bosma
authors.forename: Alexander D Montauban
authors.initials: AD
authors.lastname: van Swijndregt
authors.forename: Anco C
authors.initials: AC
authors.lastname: Vahl
mesh_terms: D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D004240:Diverticulum / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D017809:Fatal Outcome; D005260:Female; D006439:Hemodynamics; D006801:Humans; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000209:etiology; D015607:Stents / Q000009:adverse effects; D013348:Subclavian Artery / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome