A rare variation of five major vessels arising from the aortic arch with an absence of brachiocephalic trunk

The most common variations of the aortic arch branching pattern usually involve the distance between the vessels arising from it and their dimensions. Changes in the number of vessels originating from the aortic arch, ranging from one to four or more major vessels instead of the classical three vessels as independent branches, are uncommon. Incidents of branching patterns involving four independent vessels arising from the aortic arch are rare, and reports of five or six independent vessels are extremely rare. We report on a case of an absent brachiocephalic trunk associated with an aberrant right subclavian artery and five distinct major vessels arising directly from the aortic arch in a South African male. Although most congenital vascular variations are incidental findings on angiographic images, some have also been associated with cerebrovascular diseases such as cerebral aneurysms. In addition, knowledge of these rare variations is of diagnostic importance as their presence may increase the difficulty and alter the specificity of vascular procedures performed using endovascular and open techniques.