Figure 1 - uploaded by Ali Alsafi
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Three-dimensional render from a CT angiogram of the abdominal aorta demonstrating an infrarenal abdominal aortic aneurysm, occluded left common, external and internal iliac arteries, as well as an occluded right internal iliac artery. Note a markedly hypertrophic IMA supplying the pelvis (white arrow). Also, note the hypertrophic superficial external pudendal arteries providing collateral supply across the midline to the left lower limb (white arrowheads).
Source publication
The inferior mesenteric artery (IMA) is usually safely covered during endovascular aortic aneurysm repair (EVAR), but preserving it with a fenestration may sometimes be necessary. An 81-year-old man was referred for consideration of treatment of his 6.8 cm abdominal aortic aneurysm. His left iliac arteries were occluded, and he had a proximal occlu...
Context in source publication
Context 1
... left lower limb was entirely perfused via collaterals from the right femoral artery. His pelvic organs were perfused exclusively via a hypertrophic IMA (Fig 1). After interdisciplinary discussions and discussions with the patient, we elected to perform an EVAR with a custom-made Treo bifurcated graft (Bolton, Sunrise, Florida) with the left limb serving as a branch preserving the IMA and pelvic perfusion. ...
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An 81-year-old male presented to our emergency department for abdominal pain and distension. The patient had previously undergone endovascular aortic repair (EVAR) procedure 9 years ago for infrarenal abdominal aortic aneurysm with regular follow-up in postoperative. Three years ago, computed tomography angiography (CT) revealed Type Ib endoleak wi...
Citations
The inferior mesenteric artery (IMA) is often overlooked in favor of the celiac or superior mesenteric artery in arterial mesenteric ischemia, given the typically robust visceral collateral networks. Here we present a case series of patients in whom “salvage” revascularization of the IMA was performed, when attempted celiac or superior mesenteric artery revascularization was unsuccessful. Restored IMA inflow resolved symptoms in three patients, however sole IMA revascularization was insufficient to reverse the course of two other patients with severe acute-on-chronic mesenteric ischemia. The inferior mesenteric artery should be considered for salvage revascularization in the appropriate clinical scenario.
