A 77-year-old female was admitted with dysphagia and back pain. Angiography revealed an aberrant origin of the right subclavian artery from the posterior aspect of the proximal descending thoracic aorta just distal to the origin of the left subclavian artery. The origin of the right subclavian artery was aneurysmal (maximum transverse diameter was 8 cm), and this aneurysm was causing compression of the esophagus. The patient was treated by Teflon patch graft aortoplasty and right subclavian artery reconstruction with the aid of cardiopulmonary bypass and hypothermic selective cerebral perfusion. Postoperative course was uneventful and there were no major complications.