This is a case of cervical aortic arch complicated by aortic coarctation and aneurysms.  There is left-sided aortic arch with normal sequence of brachiocephalic branching (innominate, left common carotid and left subclavian artery), an excessively long and markedly tortuous aortic arch segment between the left common carotid and left subclavian arteries, and mildly hypoplastic ipsilateral descending aorta consistent with type D cervical aortic arch described by Haughton and colleagues ¹. 

The redundant segment of the aortic arch in this case also exhibits multiple saccular aneurysms which is seen in approximately 20% of cases of cervical aortic arch predominantly occurring in female patients ^2,3. 

The case is also complicated by stenosis or coarctation involving the redundant transverse segment of the aortic arch. The right internal thoracic artery, via its superior epigastric branches anastomoses with the inferior epigastric arteries, provided an important collateral in this case.