The innominate artery, also known as the brachiocephalic artery, is the first vessel off the aortic arch and provides blood to the right arm, neck and head. Occlusion of the innominate artery can be treated with endarterectomy, angioplasty and stenting as well as bypass grafting. Bypass grafting describes a surgical procedure during which a bypass from the ascending aorta to the innominate artery is created. Our case depicts a patient post innominate artery bypass graft with a less commonly encountered postsurgical anatomy.