Managing an adult patient with aortic coarctation and associated anomalies presents a significant surgical challenge. We present a case of an adult male with aortic coarctation, pre-coarctation distal arch 7-cm aneurysm involving the origin of the left subclavian artery, and aberrant (lusoria) right subclavian artery. He was managed with one surgical approach, consisting of right carotid-subclavian bypass, exclusion of the right subclavian artery, proximal descending aortic replacement and reinsertion of left subclavian artery, using partial cardiopulmonary bypass.