To depict the treatment of congenital subclavian steal syndrome in a young woman with right-sided aortic arch and occluded left subclavian artery.

A 36 year old female presented with long standing history of episodic dizziness, blurred vision and fainting. An episode of dizziness, blurred vision and shortness of breath after carrying luggage in her left hand prompted radiologic evaluation to rule out pulmonary embolism. The video depicts the MR angiogram(MRA) of the anatomy of a right-sided aortic arch and aberrant, occluded left subclavian artery with a blind-ended origin. Phase contrast MRA shows reversal of flow in the ipsilateral vertebral artery. At surgery, the left subclavian and carotid artery are exposed through an anterior approach between the two heads of the sternocleidomastoid muscle. The subclavian artery is transected and transposed onto the carotid artery.

Postoperative MRA shows reconstruction of the subclavian artery and phase contrast MRA shows antegrade flow in the ipsilateral vertebral artery. The patient's vertebrobasilar symptoms resolved.

Subclavian artery transposition provides treatment of congenital subclavian steal syndrome with reestablishment of antegrade flow into the ipsilateral vertebral artery without the need for prosthetic graft in young patients.