Upper gastrointestinal (GI) bleeding is a serious medical condition with various etiologies, including vascular anomalies like an aberrant right subclavian artery (ARSA) esophageal fistula.ARSA is a congenital anomaly that can lead to rare but life-threatening complications such as severe GI bleeding. This case report details the complex presentation and management of a 27-year-old woman with an ARSA esophageal fistula. Initially presenting with a severe headache and subsequent dural sinus thrombosis, her condition rapidly deteriorated, leading to the discovery of the ARSA anomaly and associated fistula. Management included the deployment of a covered balloon-mounted stent to seal the fistula and stop the bleeding. Despite successful intervention, the patient remained hemodynamically unstable and ultimately succumbed to cardiac arrest on postoperative day 10. This report highlights the importance of early diagnosis and multidisciplinary management in such complex cases.

Keywords: Aberrant subclavian artery, Endovascular procedures, Esophageal fistula, Gastrointestinal hemorrhage, Vascular anomalies