Abnormal Origin of the Right Subclavian Artery: A Case Report

To the Editor: A 38‐year‐old male presented with chest pain for coronary angiography to exclude coronary heart disease in the Second Affiliated Hospital of Nanchang University. During coronary angiography, a 6 Fr sheath was inserted without any difficulty after right radial artery access was obtained. However, the Loach guidewire could only be advanced to the descending aorta, and repeated attempts failed to enter the ascending aorta. Therefore, an abnormal origin of the right subclavian artery (aberrant right subclavian artery [ARSA]) was suspected. This had been confirmed by performing angiography near the origin of the right subclavian artery, which showed the right subclavian artery arising from the descending aorta. Since it will be very difficult to get to the ascending aorta through the ARSA, this approach was abandoned. The left radial artery approach was chosen, which was completed without any difficulty. An arch aortogram was also performed during left radial artery approach, which revealed the right carotid, left carotid, and left subclavian arteries (LSAs) arising from the arch as separate branches. We simultaneously inserted a Loach guidewire and a pigtail catheter into the right subclavian artery and aorta arch, which helped better delineate the abnormality and confirmed the diagnosis [Figure 1].