Aortic arch anomalies, affecting 1–2% of the population, can be classified into obstructive lesions and defects related to the position or branching of the aortic arch. Obstructive lesions include coarctation of the aorta, interrupted aortic arch, and aortic tubular hypoplasia. Postnatally, these anomalies can lead to reduced systemic cardiac output and cardiogenic shock. Chromosomal disorders, particularly in the presence of aberrant subclavian arteries, are associated with these conditions. Detecting these anomalies during prenatal care is critical. The most common anomalies include left aortic arch with an aberrant right subclavian artery, right aortic arch anomalies with an aberrant left subclavian artery, right aortic arch anomalies with mirror image branching, and double aortic arch anomalies. Prenatal assessment involves two-dimensional (2D) ultrasound, axial three-vessel and trachea view, Spatio-Temporal Image Correlation (STIC), and Tomographic Ultrasound Imaging (TUI). In addition, aortic arch abnormalities are closely associated with chromosomal abnormalities, particularly 22q11 deletion. Offering fetal karyotype analysis to families ensures comprehensive genetic evaluation. Diagnosis relies on the three-vessel and trachea view, along with detailed cardiac assessment. Color Doppler and three-dimensional (3D) ultrasound enhance the diagnostic process. Prognosis depends on the type and severity of associated anomalies, and the risk of tracheoesophageal compression. Multidisciplinary care contributes to improved postnatal outcomes.