A hernia of the esophageal aperture of the diaphragm is considered as one of the factors contributing to the development of gastroesophageal reflux disease and requires a complete and comprehensive examination of the patient. Routine esophagogastroduodenoscopy does not give a complete picture of the disease, and therefore patients receive symptomatic treatment for a long time. Paraesophageal hernia of the esophageal aperture of the diaphragm are not well understood yet due to their relatively low frequency of occurrence, may be asymptomatic or manifest as chest pain of noncardiac origin. A patient with a long history of gastroesophageal reflux disease associated with a giant paraesophageal hernia of the esophageal aperture of the diaphragm is presented as a clinical case.

The review presents the anatomical and physiological features of the system of brachiocephalic arteries (BCA) ofatherosclerotic and non-atherosclerotic nature. The prevalence of various types of BCA anomalies and the possible impact on the development of cerebral and coronary events are estimated. The modern diagnostic methods and approaches to the treatment of the problem under study are described. The need to prevent ischemia of the brain and heart in individuals with asymptomatic BCA diseases is discussed, as well as an understanding of the anatomy of the abnormal structure and variability of the BCA course, which is of paramount importance during surgical interventions.