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"Mesenteric Steal" Physiology as a Cause of Claudication and Chronic Mesenteric Ischemia
Aleem K Mirza1, J Michael Bacharach2
1Division of Vascular and Endovascular Surgery, Mayo Clinic Rochester, Rochester, MN.
Insights
Aortoiliac occlusive disease can cause leg pain and chronic mesenteric ischemia. This case study shows successful endovascular treatment of infrarenal aortic occlusion, restoring blood flow to the intestines and legs.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Gastroenterology
Background:
- Aortoiliac occlusive disease (AIOD) presents with arterial insufficiency in the pelvis and lower extremities.
- Endovascular therapies are increasingly successful for high-grade AIOD lesions.
- Infrarenal aortic disease typically spares intestinal perfusion unless visceral vessels are involved.
Abstract:
Aortoiliac occlusive disease results in varying degrees of pelvic and lower extremity arterial insufficiency. Treatment approach has evolved, and endovascular therapies are being successfully reported for high-grade lesions. However, Trans Atlantic Inter-Society Consensus D often necessitates open revascularization. Disease limited to the infrarenal segment does not typically affect intestinal perfusion in the absence of visceral aortic or mesenteric vessel involvement. Chronic mesenteric ischemia most commonly occurs due to atherosclerotic disease of 2 or 3 of the mesenteric vessels. The marginal artery of Drummond is an important component of the collateral network that allows for continued intestinal perfusion. We report a case of short-segment subtotal infrarenal aortic occlusion, proximal to the inferior mesenteric artery (IMA) in the absence of significant mesenteric disease. The patient had resultant lifestyle limiting claudication and chronic mesenteric ischemia. Angiographic evaluation demonstrated "mesenteric steal" physiology with retrograde flow via the arc of Riolan and IMA to perfuse the aortoiliac circulation. Successful endovascular recanalization with a balloon-expandable covered stent was achieved, resolving the arterial insufficiency in both the mesenteric and lower extremity vascular beds. The patient denied any symptoms on postoperative day 1 and at 1-month follow-up.