Inferior epigastric arteries as a collateral pathway in aortoiliac occlusive disease

Case contributed by Dr Bruno Di Muzio

Presentation

Aotoiliac occlusion.

Patient Data

Age: 59
Gender: Female

CTA CT Abdomen and pelvis and CTA lower limbs

Modality: CT

CT angiography shows a occluded infrarenal aorta and common iliac arteries with an extensive anterior collateral pathway to supply lower limbs blood flow - Superior epigastric arteries to the inferior epigastric arteries and inferior epigastric arteries to the external iliac arteries. 

There is also a communication between the proximal superior mesenteric artery (SMA) and the proximal inferior mesenteric artery (IMA) - Arc of Riolan. Note that the origin of IMA is occluded and this anastomosis ensure the arterial flow to it.  

 

Case Discussion

Anterior collateral pathway (also known as Winslow`s pathway) is a collateral circulation from the subclavian artery via the internal mammary artery, the superior epigastric artery, and the inferior epigastric artery into the external iliac artery. The present case only studied the abdome and lower limbs, not contemplating the thoracic vessels. 

A study demonstrated that in 95% of patients with aortoiliac occlusion, this pathway was functioning as a important collateral route providing lower-extremity perfusion.

On this case there is also a communication between the proximal superior mesenteric artery (SMA) and the proximal inferior mesenteric artery (IMA) - Arc of Riolan. Note that the origin of IMA is occluded and this anastomosis ensure the arterial flow to it.  

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Case Information

rID: 30486
Case created: 13th Aug 2014
Last edited: 10th Sep 2015
System: Vascular
Inclusion in quiz mode: Included

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