Unveiling vieussens' arterial ring: A case report of an uncommon coronary anomaly with obstructive coronary artery disease

A 47 years old hypertensive female, without family history of premature coronary artery disease (CAD) was diagnosed with chronic coronary syndrome. When the patient remained symptomatic despite Guideline Directed Medical Therapy (GDMT), coronary angiography (CAG) was done, which revealed obstructive CAD involving LCX and LAD, and Vieussens’ arterial ring connecting proximal RCA with proximal LAD and aneurysm in the left coronary sinus. Due to refractory angina with difficult anatomy, Coronary artery bypass graft was done along with ligation of the VAR artery, to combat competitive flow. While most of the case reports on VAR in literature emphasize on the beneficial effect of VAR in obstructive CAD, the present case demonstrated that despite a hemodynamically significant congenital collateral, VAR was not a saviour in aggressive CAD in a young woman.