Patients with right aortic arch, right descending aorta, and vagal left subclavian artery (vagal left subclavian artery type) combined with Stanford type B aortic coarctation are extremely rare clinically, and the diagnosis and treatment of this disease are still in the exploratory stage, with few reports from home and abroad. From December 2010 to January 2012, three patients with this disease were admitted to our hospital. 1. Data and methods Clinical data Three patients in this group, two males and one female, aged 23-55 years, two patients had previous history of hypertension. The duration of the disease was 6 months-2 years. The clinical presentation of all patients was sudden onset of thoracic back and lumbar abdominal pain with profuse sweating, without a history of tracheoesophageal compression such as dyspnea, respiratory stridor, and recurrent pulmonary infections. All patients were diagnosed with right aortic arch, right descending aorta, and vagal left subclavian artery (vagal left subclavian artery type) by aortic CTA, and all had combined Stanford type B aortic coarctation. Treatment All patients were treated surgically. All patients were treated surgically. Before the surgical treatment, relevant examinations were routinely completed, and treatment such as hypotension and analgesia were given, and thoracic descending aorta replacement and vagal left subclavian artery suture were performed as soon as possible after the vital signs stabilized. The procedure was performed under general anesthesia. The patient was placed in the left lateral position, and a right posterior lateral incision was used. According to the preoperative aortic CTA examination showing the extent of aortic coarctation involvement, all three patients entered the chest through the fourth intercostal space. After exposing the free aorta, the diameter of the vagus left subclavian artery and other indicators were judged, and the surgical method was decided. All three patients underwent thoracic descending aortic replacement and vagus left subclavian artery suture ligation by means of non-extracorporeal circulation and normothermic femoral artery pressure transfusion. 2. Results All 3 patients had a smooth surgical procedure, with operative time of 4-7 H, intraoperative transfusion of 2-6 U, postoperative awakening of 2-6 H, no complications such as neurological and left upper limb ischemic necrosis, average ICU stay of 1 day, and all were discharged cured after surgery, with hospitalization days of 7-10 days. 3, Discussion Right-sided aortic arch is a relatively rare congenital vascular anatomical variant disease with a population incidence of about 0.1％. It consists of 3 main types [2]: the mirror branching type, which is less common. From the aortic arch, the left innominate artery, the right common carotid artery and the right subclavian artery emanate sequentially. The type with vagal left subclavian artery, which is more common. The left common carotid artery, the right common carotid artery, the right subclavian artery, and the vagal left subclavian artery originating from the aortic arch in that order. Separation of the right arch from the left subclavian artery is extremely rare. Current studies in this type of patient suggest that the predilection for type B aortic coarctation is related to the hemodynamic abnormalities caused by the vascular variant of this type. The smaller diameter and curvature of the aortic arch in this type of patient results in higher shear forces on the aortic wall tissue between the right subclavian artery and the left subclavian artery, which can cause endothelial rupture of the aortic wall tissue and lead to the development of aortic coarctation. For patients with right subclavian aortic arch combined with Stanford B type aortic coarctation of the vagal left subclavian artery, the treatment method is still mainly surgical prosthetic vascular replacement. Although it has been reported in recent years that endoluminal repair with aortic overlapping stents can be used for patients with small diameters and other clear indications. However, its long-term efficacy is unclear, and there are certain requirements for the location and extent of aortic coarctation in patients undergoing this procedure, which also causes the limitations of this type of surgical approach. In this study, we successfully treated three patients with right subclavian aortic arch combined with Stanford type B aortic coarctation using conventional thoracic descending aortic replacement and vagal left subclavian artery suture surgery. Unlike the previous conventional thoracic descending aortic replacement, we should use a right posterior posterolateral incision to better expose the aortic lesion site. As for the choice of extracorporeal circulation modality, we will adopt different modalities depending on the extent of aortic coarctation involvement and the degree of dilatation. If the aortic coarctation does not involve the distal part of the aortic arch and the aortic dilatation is not obvious, we will use the thoracic descending aorta with normothermic block and right femoral artery cannula with pressure transfusion to perform the thoracic descending aorta replacement surgery. To simplify the operation and shorten the operation time. If the aortic coarctation involves the distal part of the aortic arch and the aortic coarctation lesion is severe and the aortic dilatation is serious, we use the operation under extracorporeal circulation with femoral artery cannulation and parallel transfer to improve the safety of the operation. In the three patients in this study, the aortic coarctation did not involve the distal part of the aortic arch, and the proximal expansion of the aneurysm was not obvious and easy to free, so all of them performed thoracic descending aortic replacement by non-extracorporeal circulation. The key to the management of the vagus left subclavian artery is to avoid postoperative ischemic necrosis of the left upper extremity. The vagus left subclavian artery is the main cause of dysphagia due to esophageal compression, and simple dissection of the left subclavian artery can relieve the compression symptoms. After intraoperative exposure of the left subclavian artery, the operator should accurately determine the role of the left subclavian artery in the blood supply to the head and left upper extremity based on its diameter and the amount of blood returned. If it is small in diameter and does not return much blood, it may play a minor role in the blood supply due to compression and stenosis, and can be closed by direct suturing. In this study, all three patients were sutured with the vagus left subclavian artery, and all had postoperative complications of ischemic necrosis of the left upper extremity. If the vagus left subclavian artery is thick and has a high volume of blood return, an artificial vessel can be used to bridge it with the descending aortic artificial vessel to reconstruct blood flow. In conclusion, the method of thoracic descending aortic replacement is feasible for patients with aortic right arch and right descending combined with Stanford type B aortic coarctation, and the clinical efficacy is satisfactory. Intraoperative judgment followed by suture ligation of the vagus left subclavian artery can simplify the surgical approach, but postoperative ischemic necrosis of the left upper limb should be avoided. The specific judgment method, such as the appropriate diameter range of the left subclavian artery for suture closure and the amount of blood return, still needs further study.