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Right-sided aortic arch with anomalous origin of the left subclavian artery: Case report

Vučurević Goran (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti „Dedinje”, Beograd)
Tanasković Slobodan (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti „Dedinje”, Beograd)
Ilijevski Nenad (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti „Dedinje”, Beograd)
Kovačević Vladimir (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti „Dedinje”, Beograd)
Kecmanović Vladimir (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti „Dedinje”, Beograd)
Radak Đorđe (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti „Dedinje”, Beograd)

Introduction. A right-sided aortic arch is a rare congenital defect of the aorta with incidence of 0.05% to 0.1% reported in published series. Usually it is associated with congenital heart anomalies and esophageal and tracheal compression symptoms. We present a case of a right-sided aortic arch of anomalous left subclavian artery origin, accidentally revealed during multislice CT (MSCT) supraaortic branches angiography. Case Outline. A 53-year-old female patient was examined at the Outpatients’ Unit of the Vascular Surgery University Clinic for vertigo, occasional dizziness and difficulty with swallowing. Physical examination revealed a murmur of the left supraclavicular space, with 15 mmHg lower rate of arterial tension on the left arm. Ultrasound of carotid arteries revealed 60% stenosis of the left subclavian artery and bilateral internal carotid artery elongation. MSCT angiography revealed a right-sided aortic arch with aberrant separation of the left subclavian artery that was narrowed 50%, while internal carotid arteries were marginally elongated. There was no need for surgical treatment or percutaneous interventions, so that conservative treatment was indicated. Conclusion. A right-sided aortic arch is a very rare anomaly of the location and branching of the aorta. Multislice CT angiography is of great importance in the diagnostics of this rare disease.

Keywords: right-sided aortic arch, supraaortic branches, subclavian artery