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Anatomical variations of the great vessels, including the aorta and its major branches, represent a significant challenge in both cardiac surgery and the management of aortic pathology. While the standard anatomical configuration of the aorta and its branches is well-established, variations in the branching patterns, origins, and course of the great vessels can lead to complications during surgical interventions, diagnostic imaging, and the management of aortic diseases. This article explores the various anatomical variations of the great vessels, such as aberrant right subclavian arteries, coarctation of the aorta, and double aortic arches, and discusses their implications for cardiac surgery, aortic aneurysms, and other aortic pathologies. Understanding these variations is critical for improving surgical outcomes, facilitating accurate diagnosis, and providing personalized treatment plans in patients with these unusual vascular anatomies.