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A 70-year-old female had an ascending aortic aneurysm (58 mm) that required replacement of the aortic arch with a prosthetic tube. Computed tomography (CT) imaging identified unusual origin of the supra-aortic trunks (SATs). The independent origins of 5 supra-aortic vessels were as follows (from proximal to distal aorta): right common carotid (from which the right vertebral artery arose abnormally), left common carotid, left vertebral artery, left subclavian artery, and right subclavian artery. The latter had an abnormal path (Fig. A-D, Video 1*). The multiple anomalies in the origin and path of the SATs occurring with the aortic aneurysm were remarkable. Aberrant right subclavian artery (ARSA) is the most common anomaly of the SATs. It originates as a result of abnormal regression of the right 4th embryologic arch, and is more prevalent in patients with chromosomal disorders like Down syndrome or with other cardiac defects.

Association of several anomalies of supra-aortic trunks and surgically corrected aortic aneurysm