Anomalous origins of the right vertebral, subclavian, and common carotid arteries in a patient with a four-vessel aortic arch

Many anomalies of the aortic arch and great vessels are uncovered as serendipitous findings on imaging studies, in the anatomy laboratory, or at surgery. A 56-year-old man had an arch angiogram as part of an evaluation for cerebrovascular disease. A four-vessel left aortic arch was identified consisting of the right carotid, left carotid, right subclavian, and left subclavian arteries. The right common carotid gave rise to the right vertebral artery in the chest while the normally located left vertebral arose from the left subclavian artery. No aneurysm or aortic diverticulum was identified.