Vertebral Arteria Lusoria and Five Vessel Aortic Arch: A Rare Aortic Arch Branching Anomaly.

Vertebral artery (VA) lusoria is an unusual variation of the VA origin and course, characterised by the direct origin of the right VA (RVA) from the aortic arch (AoA) instead of the right subclavian artery (RSCA). Generally, this condition remains asymptomatic and is diagnosed during computed tomography angiography (CTA) or catheter angiography performed for evaluation of other cardiac or extracardiac pathology. The surgeon and physician must be aware of this VA-origin anomaly before undergoing surgery or angiography, as injury to this vessel can be catastrophic and lead to torrential haemorrhage or brain stem infarction. This anomaly can occur in association with other branching anomalies, like the left VA originating from the arch and the bovine arch. We are reporting an unusual case of aberrant RVA in a five-vessel aortic arch We aim to highlight the importance of CTA in detecting these anomalies of origin and course and their clinical implications.