Congenital subclavian steal syndrome with anomaly of the aortic arch

A case of congenital subclavian steal syndrome associated with an anomalous right-sided aorta is reported. A 41-year-old man complaining of vertigo and a loss of consciousness was admitted. Physical examination revealed a blood pressure differential between the arms that was 20 mm Hg less in the left. Aortography showed a right aortic arch from which arose the right subclavian and both common carotid arteries. The left subclavian artery did not opacify. Right vertebral angiography showed retrograde filling of the left vertebral. A left carotid-subclavian by-pass was performed. Postoperatively, the patient is symptom free with equalized blood pressure.