Agenesis of the right external iliac artery in a 23-year-old woman with left leg ischemia

External iliac agenesis is an uncommon congenital issue characterized by the absence or incomplete development of the external iliac artery, a significant blood vessel supplying the lower limbs, potentially causing symptoms like pain, weakness, ischemia, and numbness. We are currently discussing a case of a 23-year-old woman who complained of pain in her left lower limb. A thorough work-up was conducted to rule out ischemia, and during the diagnostic process, a CT scan revealed the complete absence of the right external iliac artery. It can be concluded that this is a rare vascular anomaly that can lead to significant morbidity and mortality. Early diagnosis and prompt management are crucial for preventing complications such as limb ischemia and gangrene.