The branches of the abdominal aorta (AA) consist of paired

visceral branches, unpaired visceral branches and parietal

branches. Paired visceral branches include suprarenal, renal

and gonadal arteries. Unpaired visceral branches include the

coeliac trunk (CT), the superior mesenteric artery (SMA) and

the inferior mesenteric artery (IMA). Parietal branches

include the inferior phrenic arteries and the lumbar arteries.

The development of the abdominal aorta starts in the third

week of embryological development by the migration of cells

from the endocardial mesenchyme, forming two dorsal

aortas, which later fuse to form the abdominal aorta. Some of

the primitive segmental branches regress over time, and

others branch or make connections with other segmental

branches to give origin to a final, definite set of branches.

Aberrations of this mechanism can give rise to aberrant

branches, accessory branches and abnormal divisions. This

causes high prevalence of variations of visceral branches of

the aorta in terms of level of origin, branching patterns, trunk

formation and course. These variations, especially in the

visceral branches, are significant clinically, requiring

awareness among surgeons,radiologists, and interventionalists

to avoid complications inprocedures like transplantation,

angioembolization, and aneurysm repair. We discuss a case of

a patient who presented with a thoraco-abdominal aortic

aneurysm (TAAA) with multiple variations of visceral

anatomical branches. The case is reported due to the rarity of

such presentations and the implications of such variations on

aortic surgeries.