The right aortic arch with mirror-image branching of brachiocephalic arteries and aplasia of the left brachiocephalic trunk: surgically cured rare cause of cerebrovascular insufficiency.

A clinical case with rare anomaly: right aortic arch with mirror-image branching of brachiocephalic arteries and aplasia (isolation) of the left brachiocephalic trunk, causing cerebrovascular insufficiency and left arm claudication is described. Despite the clear neurologic manifestations of cerebrovascular insufficiency and absence of the pulse on the left arm, the pathology was not diagnosed until 35 years of age. The anomaly was diagnosed and surgically cured in the Department of Vascular Surgery of Vilnius University Emergency Hospital. Using transsternal median thoracotomy approach, 12 mm diameter PTFE vascular graft, arising from the ascending aorta and connected to the angle, made of branching left common carotid and left subclavian arteries, was implanted into the position of missing left brachiocephalic trunk. 3 years after surgery patient feels healthy and is working. To our knowledge this is the first reported case of surgical replacement of missing left brachiocephalic trunk in the right-sided aortic arch with mirror-image branching of brachiocephalic arteries.