Subclavian steal syndrome in a right aortic arch with aberrant left subclavian artery atresia

Congenital aortic arch anomalies are an uncommon diagnosis resulting from embryologic malformations during the fourth to eighth week of gestation. Asymptomatic variants frequently are overlooked in the perinatal period and diagnosed incidentally during adulthood. Symptomatic variants can present with steal syndrome or dysphagia lusoria. The right aortic arch is a rare anomaly that is usually associated with other congenital anomalies but can occur in isolation. The most common types of right aortic arches are mirror image branching or an aberrant left subclavian artery. Aortic arch anomalies are important to recognize as they may have important implications in management. We present a 74-year-old female with a right aortic arch and aberrant left subclavian artery that was discovered after a fall. An extensive evaluation and work-up revealed symptoms consistent with subclavian steal syndrome that resolved following a carotid-axillary bypass. Subclavian steal secondary to a right aortic arch is extremely rare. This report reviews the current literature of a right aortic arch with an aberrant left subclavian artery presenting as a subclavian steal syndrome.