Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 02 23 1489 1489 Sonal Khatavkar Department of Anaesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India. Ishan Garud Department of Anaesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India. Mounika Yerramshetty Department of Anaesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India. 2025 11 15 2025 12 07 Double aortic arch (DAA) is a rare congenital vascular anomaly that forms a complete vascular ring encircling the trachea and esophagus, potentially leading to respiratory and feeding difficulties. We present a case of a 15-month-old male with an incomplete cleft palate who had an incidental finding of codominant double arch of aorta on preoperative imaging. The child underwent successful cleft palate surgery under general anesthesia with appropriate airway precautions and multidisciplinary planning. This report highlights the anesthetic implications of vascular rings and the need for thorough preoperative assessment in children presenting with non-specific symptoms like recurrent upper respiratory tract infections (URTI) and feeding intolerance. https://aacc.tums.ac.ir/index.php/aacc/article/view/1489