This child had dysphagia and a pulsatile mass at the base of the neck on the right. You can almost make the diagnosis on that alone, but the angiogram confirms that there is a right aortic arch with a cervical apex. I will not go into the embryology of arch anomalies as it is well done in most textbooks. If you know your arch anomalies, you will recognise that the black arrow points to the retro-oesophageal right descending aorta, passing to the left in a rather abrupt manner. You will also have noticed the aberrant left subclavian artery (white arrow) and the fact that the first branch of the ascending aorta is the left common carotid.
This is an ancient cut film angiogram from before the days of cinefluorography. At the time, we were not fond of Seldinger arterial puncture in children, a mixture of unfamiliarity and some rather rough catheter materials. Instead we preferred to do an open axiliary arteriotomy and direct repair. It was rather like the brachial cut-down favoured by Mason Sones in the adult, which also has given way to modern percutaneous techniques.