Coronary Artery Anomaly With Absent Common Iliac Artery and Genitourinary Malformation: A Rare Case Report

Congenital coronary artery anomalies are rare, and while often asymptomatic, some anomalies can pose life-threatening risks. Peripheral vascular anomalies, particularly involving the iliac arteries, are even rarer and may go undetected unless complications arise. Their presence can significantly impact interventional and surgical strategies, particularly when extracorporeal circulatory support is required during cardiac surgery. We report a rare case of a 37-year-old male presenting with acute coronary syndrome and an anomalous left circumflex coronary artery originating from the right coronary sinus. Coronary angiography revealed multivessel disease, and the patient underwent coronary artery bypass graft surgery. Preoperative imaging revealed the absence of the right common iliac artery, with the distal right external iliac artery reconstituted by collateral circulation. Additionally, an ectopic, malrotated left kidney was identified. The postoperative course was uneventful, and the patient was discharged on the seventh postoperative day. This case highlights the importance of suspecting other congenital vascular anomalies in patients with congenital coronary artery anomalies, as these anomalies can pose significant challenges, particularly when mechanical circulatory support is required after coronary artery bypass graft surgery. A comprehensive preoperative imaging workup, including Doppler sonography and thoracoabdominal and pelvic CT, is crucial for detecting such anomalies early, ensuring optimal surgical planning, and avoiding intraoperative surprises.