Right Aortic Arch With Isolation of the Left Subclavian Artery: Case Report and Review of the Literature PATRICK H. LUETMER, M.D., GARY M. MILLER, M.D.

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Right Aortic Arch With Isolation of the Left Subclavian Artery: Case Report and Review of the Literature PATRICK H. LUETMER, M.D., GARY M. MILLER, M.D. Mayo Clinic Proceedings Volume 65, Issue 3, Pages 407-413 (March 1990) DOI: 10.1016/S0025-6196(12)62540-3 Copyright © 1990 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 1 Frontal chest roentgenogram, demonstrating right aortic arch. Mayo Clinic Proceedings 1990 65, 407-413DOI: (10.1016/S0025-6196(12)62540-3) Copyright © 1990 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 2 Digital subtraction aortograms (A and B) in right anterior oblique position and corresponding diagram (C). A, Early film demonstrates three vessels arising from the aortic arch in the following order: left common carotid artery (straight arrow), right common carotid artery (arrowhead), and right subclavian artery (curved arrow). Catheter tip is in ascending aorta (open arrow). B, Late film demonstrates opacification of left vertebral artery (small arrows) and isolated left subclavian artery (large arrow). C, Line drawing depicts aortographic findings, a. = artery; subclav. = subclavian. Mayo Clinic Proceedings 1990 65, 407-413DOI: (10.1016/S0025-6196(12)62540-3) Copyright © 1990 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 3 Posteroanterior digital subtraction angiograms with catheter tip in proximal right vertebral artery. A, Early film demonstrates retrograde opacification of left vertebral artery from right vertebral artery across vertebrobasilar junction and by muscular collateral vessels in the neck. B, Late film demonstrates retrograde flow from left vertebral artery into isolated left subclavian artery. Mayo Clinic Proceedings 1990 65, 407-413DOI: (10.1016/S0025-6196(12)62540-3) Copyright © 1990 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 4 Posteroanterior angiogram of right common carotid artery, demonstrating an approximately 3-cm intracavernous aneurysm of right internal carotid artery and an angiographically azygous anterior cerebral artery that fills from the right. Mayo Clinic Proceedings 1990 65, 407-413DOI: (10.1016/S0025-6196(12)62540-3) Copyright © 1990 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 5 Diagram of ventral view of hypothetical double aortic arch, modeled after description reported by Edwards and associates.1,3 A right arch with isolated left subclavian artery can be explained by regression of the left arch at two locations indicated by arrows 1 and 2. a. = artery; Ao = aorta; L.P.A. = left pulmonary artery; P.T. = pulmonary trunk; R.P.A. = right pulmonary artery. Mayo Clinic Proceedings 1990 65, 407-413DOI: (10.1016/S0025-6196(12)62540-3) Copyright © 1990 Mayo Foundation for Medical Education and Research Terms and Conditions