World’s first surgical repair of bilateral common iliac artery agenesis

We present a rare case of a 23-year-old woman with congenitally absent bilateral common iliac arteries, identified incidentally during a computed tomography scan of the abdomen. Imaging revealed occlusion of the aorta below the renal arteries with flow to the lower limbs provided by hypertrophied collaterals. Despite initial conservative management, the patient experienced worsening claudication and functional limitations, prompting surgical revascularisation. An aorto-bifemoral bypass using an axillary-bifemoral graft was performed with successful recovery - the first documented case of surgical repair of this anatomical abnormality, and a novel use of the Gore heparin-bonded graft. Two years post-surgery, the patient was symptom-free. This case highlights the rarity of common iliac artery agenesis, the compensatory role of collateral circulation, and the potential for successful surgical intervention.