Kommerell’s Diverticulum with aberrant right subclavian artery

Hi @dsr
I did have a thoracotomy. I actually had a surgery through my neck though to relocate my ARSA, a vascular surgeon did that the first day, the second day the cardiac surgeon repaired my aortic and left subclavian aneurysms via thoracotomy(if I didn’t have those I would have my ARSA still because it had no aneurysm or ring, it was just in the way of the repair needed on my aorta from the other aneurysm). After that I spent a few hours in ICU then to the floor and was discharged 8 days later- flew home the next day to Florida. I was up to a chair and walking to bathroom about 8 hrs after surgery- not well and not easily but they don’t give you much choice. I am a pretty active person and had 2 kids (14, 11) at the time so I was motivated to get moving:). I did not have any therapy- cardiac or physical- and really did not have any complications. It’s 3 years later now and I run 2-3 miles every day - and am doing really good. Hope this helps answer some of your questions. Best wishes!

Jeane

I was referred to Mayo Rochester by my cardiologist in Florida. I saw Dr. Bowers for vascular surgery and Dr. Pochettino for cardiac. My aberrant right subclavian was really unremarkable though- no enlargement or ring or really any issues. I was found to have a kink in my aortic arch that caused an aortic aneurysm and left subclavian aneurysm and to repair the aorta they had to relocate the aberrant right subclavian. Your case sounds more complicated with an actual Kommerals and other issues. I was very happy with Mayo and its doctors and would highly recommend.

So I am desperately trying to find others with a left aortic arch and right aberrant subclavian artery. I have been symptomatic for years but thought it was because of my poorly controlled asthma. Then when I started choking on food and having dysphasia every week they sent me for a barium swallow study. Long story short, now diagnosed with ARSA and have differing opinions on whether or not Kommerells Diverticulum is significant. Saw a surgeon at a well known US hospital but he’s making this seem like this is such an easy surgery. Only need to stay 1 day and back to normal in 2 weeks. However this is not what I’m hearing from several on this sight. Any insights into similar situations and your experiences would be forever appreciated!

I have been told when/if you become symptomatic. Apparently people have ARSA and just by chance happen to find but unless it’s symptomatic or there is an aneurism it’s usually left alone. My symptoms are shortness of breath, dysphasia, choking on even small pills, some chest pain, etc. my ARSA has pushed into the back of my esophagus and is limiting my ability to eat and breath normally.

Hi. So, I found my ARSA (right & left) last year and subsequently had the surgery in November 2022. I don't know what area of the country you're in, and I see that this is from March, but this was not an "easy" surgery. By any means. Kommerells Diverticulum, in my opinion as a 20+ year cardiac RN, is ALWAYS significant, as if it ruptures, that's end game. I wasn't taking any chances; and mine was 3cm at the time of surgery. This was not a 1 day, back to normal in 2 week ordeal, but everyone is different. I won't lay it all out here, but you can feel free to message me if you'd like to know more. I do hope that you've found relief.

@lalasmomallie
I had an ARSA. I had several other problems with it- that required their own surgery. My ARSA was not aneurysmal. I would not have had it relocated if it was not in the way of my other issues (CoA). Which ironically caused a left subclavian aneurysm- 3.4mm in size. My surgery(s) were done at Mayo. It was a short surgery through my neck- about a 5 in incision. My ARSA was moved to the carotid. I had one drain after surgery to help with swelling- it was pain wise pretty rough the first night- but then ok. But I also had open heart(thoracotomy) the next day to repair the aorta and left subclavian artery. My ARSA did not ring around my esophagus or impeded on anything. The surgeon thought it would have never bothered me or became symptomatic if it had stayed. I think surgery wise it would depend on how many structures are affected to determine how difficult the surgery would be and that would I am sure affect recovery. I would get at least 2 opinions- this is still a fairly rare finding- try university centers or bigger cardiac centers. Best wishes…. Take care

Jeane Abbas

Seeking Advice on Aberrant Right Subclavian Artery and Ongoing Health Concerns

Hello @lalasmomallie, @mrsr1234,

I've recently discovered that I have an Aberrant Right Subclavian Artery (ARSA) which branches from the posterior arch and goes behind my esophagus. This diagnosis came after four years of persistent, unexplained chest pain, and shortness of breath. Though I had multiple tests with my cardiologist, I was told that my heart was fine. "In 2019, an MRA neck scan revealed both a blockage in my Carotid artery and the presence of ARSA. While the doctor informed me about the blockage, the ARSA finding was neither communicated to me nor added to my medical records."

Fast forward to last year, I had a bone scan at the Mayo Clinic that also identified the ARSA. However, this was never communicated to me either. My local endocrinologist was the first to point it out during a recent consultation to figure out the source of my daily chest pain. He's now scheduled a Barium swallow test for me, suspecting Dysphagia induced by ARSA.

Last year, I sought treatment at the Mayo Clinic for debilitating leg pain, weakness, and additional symptoms including chest pain. Despite multiple tests, they could not diagnose my condition, leading me to discontinue my visits. Over the past three months, my symptoms, including chest pains, swallowing difficulties, and high blood pressure—even on medication—have worsened. I've also experienced severe headaches and moments of dizziness.

I reached out to the Mayo Clinic again and have an appointment scheduled for October. Interestingly, they were not even aware that ARSA had been indicated in the bone scan they conducted last year until I showed them the proof.

I'm feeling incredibly stressed and am seeking anyone who has information or has dealt with similar issues. I've found limited research online, with some information available on the Johns Hopkins website. I see that a few members here had surgery for this condition. I'm desperate for answers, as my condition worsens by the day.

Thank you for taking the time to read this lengthy post. Any information or advice would be greatly appreciated, as I can't wait until October for answers.

Best regards.

So, I will start with, a not comforting statement, of I know how you feel. I was in and out of the ER too many times to count and the cardiologist told me twice that “it wasn’t my heart” (guess he missed it on the radiology report) but I have the zipper (open heart surgery scar) to prove it. Anyway, I would think that once Mayo gets the correct diagnosis, either there or Johns Hopkins would be your best bet. I should’ve gone to Hopkins. That’s a different story. I’ve been a cardiac RN for 20+ years and found and basically diagnosed myself which is how I ended up at the surgeon. However, the barium swallow is ‘gold standard’ for diagnosis as it will really show the ARSA obstruction (as mine did) - fyi… it sucks if you’ve never had one before. Words of advice: research your surgeon. And I cannot stress this enough: STAY OFF GOOGLE. It is not your friend. I have reputable peer-reviewed articles and sites regarding this subject if you’d like them. Let me know if you have any questions. Keep your head up it’s a marathon not a sprint.

Thank you so much! I would love the articles and all the info you have. I really appreciate it.

I would appreciate the articles and info as well.
Thanks!