Silent double aortic arch coincidentally found during cardiac catheterization in elderly man

Area of Science:

• Cardiology
• Vascular Surgery
• Medical Imaging

Background:

• Coronary artery disease (CAD) management often involves interventions requiring detailed vascular imaging.
• Previous coronary artery bypass graft (CABG) surgery can complicate subsequent angiographic procedures.
• Anomalous aortic arch origins are rare congenital vascular anomalies.

Observation:

• An elderly male patient with a history of CABG presented with inferior wall ischemia.
• Selective engagement of the left subclavian artery via femoral access was not feasible.
• Left internal mammary artery (LIMA) grafting was visualized via a right radial approach.
• A suspicious origin of the left subclavian artery was noted, but a full aortic angiography had not been performed.
• During a subsequent coronary angiography, a double aortic arch was incidentally visualized using a left Amplatz catheter.

Findings:

• The incidental finding of a double aortic arch was confirmed via a 64-slice computed tomography scan.
• This case highlights a rare congenital vascular anomaly presenting in an elderly patient with established cardiovascular disease.

Implications:

• Accidental discovery of rare congenital anomalies during routine procedures can occur.
• Awareness of potential vascular anomalies is crucial for interventional cardiologists and vascular surgeons.
• Further investigation may be warranted in patients with unexplained vascular access difficulties or suspicious findings on imaging.