Kommerell’s Diverticulum with aberrant right subclavian artery

I’m happy to see this thread has some recent conversations. Clinic? I was found to have a right aortic arch with an aberrant left subclavian artery and Diverticulum of Kommerell on an MRI due to my cardiologist hearing a Brue. I’m 36, My cardiologist wasn’t concerned and said he would scan me again in a year which I’m due for now. I don’t know the size and when I asked at my appt the other week they said it wasn’t reported. I’m going to ask that they find out with this next scan. I was wondering what treatment options vs wait and see people have had. Is Mayo where the top physician’s for this are? I can’t even figure that out much less and kind of standard of care as the research is so lacking. Does anyone know if Mayo is doing any type of virtual consults right now. I live in MI and have a 1 and 3 yr old so traveling is not ideal right now.

Hi Jeane,

Thank you so much for the response. Is a vascular surgeon the right one to do this? Or cardio? Or thoracic? Or cardiothoracic? What made you go with a vascular surgeon?

Thank you,
Alex

Hi!! So sorry to hear you had to go through all of this. I had aberrant right subclavian. I had surgery Nov 2019 at Mayo Rochester with Dr. Bower. My case is unique in the sense- i had no symptoms whatsoever. I also had no dilatation of the aberrant artery. I did have a large left subclavian aneurysm and descending aortic aneurysm. My cardiologist here in Florida sent me to Mayo right away, and with Dr. Bower and Dr. Pochettino help I had a 2 day surgery-- day one Dr. Bower relocated my aberrant artery to my carotid( only because it was in the way for my aortic grafts I needed) and day 2 Dr. Pochettino replaced a large portion of my aorta and left subclavian. I highly recommend if you are needing a second opinion trying Mayo. Not many doctors know how to approach an aberrant artery. If your not having symptoms it may just require some routine imaging--mine was a Ct scan. I was told the main issue with this is the development of Kommeralls diverticulum-- which is basically an aneurysm on the right subclavian-which doesn't happen all the time. Dr. Bower told me that if I did not need the aberrant artery moved because it was in the way of the graft for my other issues- he doubts my aberrant artery would have ever caused me any issues. I highly recommend before you panic to see a dr who is well experienced with this issue like Dr. Bower. It really did help me. Best wishes.

Jeane

I bet! I can't imagine that weighing on your conscience every day. They do have different approaches for symptomatic versus asymptomatic patients.

Hybrid endovascular treatment for an asymptomatic Kommerell diverticulum at the right aortic arch - https://www.jvascsurg.org/action/showPdf?pii=S0741-5214%2816%2900263-9

This one is lengthy, but it is a Mayo Clinic Proceeding
https://www.mayoclinicproceedings.org/action/showPdf?pii=S0025-6196%2812%2960196-7
Were you able to make an appointment with the vascular surgeon to get a second opinion?

The idea I may just drop dead randomly is really, really scaring the living day lights out of me...

Asymptomatic. In fact as of last week I was doing an hour of hardcore cycling and heavy weightlifting 6 days a week. I am just in horror that I may have been literally risking my life with each rep. It is beyond frustrating that is wasn't addressed when it came up and I was young (in my 20s).

Hi @akeyfes, welcome to Mayo Clinic Connect. How disheartening to know that something was found on your imaging, but not addressed.
I know that members like @jbell22 and @ggopher who not only posted here, but also in another discussion regarding kommerell diverticulum.
https://connect.mayoclinic.org/discussion/right-facing-aorta-with-kommerellis-diverticulum/
You may be interesting in this NIH article as well:
- Kommerell's diverticulum: A rare aortic arch anomaly https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5192231/

Have you been asymptomatic or have you had any swallowing or breathing issues?

Hi, not sure if this is still active. I am going to see a specialist for unrelated issues and was going through old reports/data. I am 37 year old male and 10 years ago, doctor thought I had cancer and wanted to see if it spread so did a chest CT scan. It turned out to be false alarm and he was wrong and there was no cancer anywhere. I just looked at the report and actually read it where it mentions incidental finding of aberrant right subclavian artery stemming from diverculosis kommerell. The doctor never brought this up to me 10 years ago. I am in the process of setting up appointment with a vascular surgeon and would imagine I need current imaging. Have any of you have this? Is this something that you just live with and it's not an issue? What sort of lab work/imagining did you have on this? Did you put in stents? Any info on this would be much appreciated! There is really not much on the web about this.

Thank you!

It is very unsettling and difficult to not think about. I live in B.C. and my surgery was at St. Paul's Hospital in Vancouver, B.C. - I live on Vancouver Island. Sadly, the Mayo Clinic is not an option for me unless I win a lottery. There is a 2016 study out of Virginia that says KD's should 'be called Kommerellis Aneurysm and not Kommerellis Diverticulum because of their unpredictability and catastrophic nature' and it goes on to explain why. My surgeon called it an aneurysm but my cardiologist now feels as your does that it shouldn't be under the aneurysm umbrella, that they are unlikely to rupture or rare to rupture but considering what we have is very rare, it seems par for the course. I hope this isn't too much negative stuff and I apologize if so.

Thank you for your reply. May I ask where you are being treated? I hope everything goes well with your second surgery if needed. My physician said it’s very rare for it to rupture but then told me to keep something on me with the diagnosis just in case. He said otherwise just live life normally. I have 2 little ones and the idea of it rupturing terrifies me. It’s just so hard to find info on it and I’m not sure how familiar my cardiologist is with it. When giving me the results of my MRI he didn’t even mention it by name but I asked about it because I had already read the MRI report on my my chart Before seeing him. Then after I asked about it is when he said we would scan again in a year. If I wouldn’t have brought it up we wouldn’t do anything. I feel like from what o have read it doesn’t seem like it’s a problem until later years of life but I kind of feel like a ticking time bomb. It’s very unsettling.