Ana SU?I?, Gabriela ?IVKOVI?, Edi Paleka BOSAK, Vinko VRDOLJAK, Alen ?VIGIR, Katarina BOJANI?
The Turkish Journal of Pediatrics - 2026;68(5):855-859
Background. Congenital malformations of the external iliac arteries (EIAs) are rare and may be associated with other congenital anomalies, such as vertebral, cardiac, or limb anomalies, anal atresia, and tracheoesophageal fistula (VACTERL). These anomalies can be classified into three categories: anomalies of origin or course, hypoplasia or atresia with a persistent sciatic artery, and isolated hypoplasia or atresia. We report a term neonate with left leg cyanosis within the first 48 hours of life due to an isolated congenital EIA malformation. Case Presentation. A male term neonate was delivered by emergency cesarean section at 40 weeks' gestation for suspected asphyxia (birth weight 4040 g, length 52 cm, Apgar scores 10, 10). The pregnancy was uncomplicated except for gestational diabetes. The neonate showed no signs of distress or cyanosis at birth. Asymptomatic hypoglycemia was corrected with oral glucose. On the second day of life, the neonate developed cyanosis of the left lower limb, accompanied by delayed capillary refill (6 seconds), weak distal pulses, and reduced oxygen saturation (60-70%) as measured by pulse oximetry. Echocardiography excluded cardiac defects. Doppler ultrasound revealed high-grade stenosis of the left EIA, which was confirmed by magnetic resonance angiography, showing collateral circulation and no persistent sciatic artery. Coagulation tests were normal, and the neonate remained asymptomatic. At the 1-year follow-up, he demonstrated normal growth and neurodevelopment, with clinically normal development of the affected lower limb. Conclusions. Neonatal limb cyanosis should prompt further evaluation after excluding other, more common conditions. Persistent cyanosis, especially when accompanied by weakness, atrophy, or length discrepancy, should raise suspicion for EIA malformations. To the best of our knowledge, this is the third reported case of EIA malformation and the first case of congenital segmental stenosis in a neonate. Despite their rarity, these malformations require consideration and early non-invasive imaging in unilateral limb cyanosis.
