Congenital absences of the iliac artery: a systematic review of clinical presentations and anatomical patterns, with case illustration

INTRODUCTION: Congenital anomalies of the iliac arterial system are rare and may present across a spectrum from incidental findings to severe limb ischaemia. Their anatomical distribution and clinical implications remain poorly characterised. METHODS: A systematic review of PubMed, Embase and Google Scholar was conducted to identify cases of congenital absence, hypoplasia or atresia of the common, external or internal iliac arteries. Data were extracted on anomaly type, laterality, associated vascular abnormalities, ischaemic symptoms and diagnostic modalities. Statistical analysis examined associations between multilevel anomalies and ischaemia. To illustrate the findings, we describe a patient with complete unilateral iliac agenesis but preserved distal perfusion. RESULTS: = 0.022). A persistent sciatic artery was present in 20% of cases and frequently served as a compensatory pathway. Patients with isolated agenesis were less likely to develop ischaemia owing to well-developed collateral circulation. Our representative case, a diabetic patient with a traumatic foot ulcer, healed over 3 months with preserved limb perfusion, highlighting that isolated iliac agenesis can be an incidental finding. CONCLUSION: Multilevel congenital anomalies of the iliac system are strongly associated with ischaemia, whereas isolated agenesis may be haemodynamically compensated and clinically silent. Recognition of these variants is important for accurate diagnosis and safe surgical planning, particularly in vascular, orthopaedic and transplant procedures.