Common and Rare Collateral Pathways in Aortoiliac Occlusive Disease: A Pictorial Essay

Hardman, Rulon L.; Lopera, Jorge E.; Cardan, R; Trimmer, Clayton; Josephs, Shellie C.

doi:10.2214/ajr.10.5896

Cited by 74 publications

(61 citation statements)

References 11 publications

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“…We believe the formation of the arc of Riolan provided an additional source of blood flow toward the aneurysm sac, increasing intra-aneurysmal pressure distal to the aortic stenosis, same explanation to the collateralization between the intercostal arteries and deep circumflex artery. 5 …”

Section: Discussionmentioning

confidence: 99%

An infrarenal abdominal aortic aneurysm with severe neck stenosis

Ren

Tian

et al. 2015

Journal of Vascular Surgery

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A 54-year-old woman was admitted for a pulsatile mass in the periumbilical area; an aortic dilatation was found by ultrasound examination. Her medical history was significant for smoking, hypertension, and hypercholesterolemia. On review of systems, she had no history of back pain, lower extremity claudication, or postprandial abdominal angina. On physical examination, the feet were warm and their skin was intact; the pedal pulses were palpable bilaterally.Computed tomography angiography demonstrated severe localized aortic stenosis 1 cm inferior to the ostium of the renal artery with an abdominal aortic aneurysm starting just below the stenotic lesion (A/Cover). In addition, both common iliac arteries were dilated. The internal iliac, external iliac, and infrainguinal arteries were patent without stenosis or dilatation bilaterally. The inferior mesenteric artery was enlarged, widely patent, and consistent with the arc of Riolan (B). The visceral arteriesdceliac, mesenteric, and renal arteriesdwere also patent without abnormality. Besides the arc of Riolan, another collateral pathway was also seen between the intercostal arteries and deep circumflex artery (B). Open surgery was performed, the aneurysm was repaired with a bifurcated prosthesis (Gore-Tex), and the inferior mesenteric artery was ligated. Her recovery was uneventful, and a follow-up at 1 year showed no recurrence. DISCUSSIONIn the treatment of abdominal aortic aneurysm, endovascular aneurysm repair (EVAR) has become the first-line therapy. 1 In many cases with suboptimal morphology of the proximal neck, including shortness, angulation, and dilation, EVAR has been successfully performed because of device development. However, there is very little experience in endovascular treatment of abdominal aortic aneurysm with stenotic proximal neck. In this patient, the proximal neck was too angulated and stenosed to be used for EVAR. We thought that open surgery was the optimal method.Aneurysm formation and focal stenosis are common lesions respectively in the infrarenal abdominal aorta. 2 However, it is rare that both kinds of lesions are concomitant and adjacent to each other. It is important for the formation of the aortic aneurysm to have sufficient blood pressure be exerted against the vessel wall. 3 If the stenosis is significant, the blood pressure distal to it is reduced. So we believe that the stenosis formed after the aneurysm formation.

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Section: Discussionmentioning

confidence: 99%

An infrarenal abdominal aortic aneurysm with severe neck stenosis

Ren

Tian

et al. 2015

Journal of Vascular Surgery

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“…11 The middle colic branch of the SMA joins the left colic branch of the inferior mesenteric artery and continues into the pelvis as the superior hemorrhoidal artery. 11 This communicates with the middle hemorrhoidal branches of the internal iliac artery. This pathway is more prevalent if the aortic occlusive disease extends cephalad along the aorta, approaching the renal arteries.…”

Section: Discussionmentioning

confidence: 99%

Sonographic Discovery of Leriche Syndrome and the Development of Collaterals

Barry

2014

Journal of Diagnostic Medical Sonography

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Leriche syndrome, also referred to as aortoiliac occlusive disease, is complete occlusion of the infrarenal aorta and bilateral common iliac arteries. The development of collateral pathways allows reconstitution of arterial blood flow to the lower extremities, preventing limb ischemia. Patients typically present with a triad of symptoms, which include intermittent claudication of the buttocks and thighs, decreased or absent femoral pulses, and impotence in men. Sonography may play a significant role in diagnosing Leriche syndrome, particularly in cases with contraindications to other more invasive tests. Knowledge of the presentation of aortoiliac occlusion along with recognition of developing collateral pathways assists with the diagnosis and management of this disease.

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“…The latter include the celiac, superior mesenteric, inferior mesenteric, or median sacral artery via rectal arteries to the internal iliac artery. More rarely gonadal or renal arteries can collateralize the iliac system (7). Systemic collaterals share a common embryologic origin from the dorsal arterial supply, whereas visceral collaterals arise from the ventral or lateral arterial supply.…”

Section: Case Studymentioning

confidence: 99%

A Path to Avoid during Transcatheter Aortic Valve Implantation: Case Report

Palma¹,

Settergren²,

Rück³

et al. 2016

Radiology

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Collateral pathways in vascular disease are important natural "bypass" conduits that protect against ischemia. Endovascular diagnostic and therapeutic procedures via peripheral access sites are performed frequently. This case report underlines the importance of being aware of collateral circulation in patients with chronic aortoiliac occlusive disease undergoing subclavian transcatheter aortic valve implantation to avoid acute limb ischemia. (©) RSNA, 2016.

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Common and Rare Collateral Pathways in Aortoiliac Occlusive Disease: A Pictorial Essay

Abstract: Common and rare arterial collateral pathways are reviewed by 3D volume-rendered CT images. Visceral and lower extremity arterial embryology is reviewed.

Cited by 74 publications

References 11 publications

An infrarenal abdominal aortic aneurysm with severe neck stenosis

An infrarenal abdominal aortic aneurysm with severe neck stenosis

Sonographic Discovery of Leriche Syndrome and the Development of Collaterals

A Path to Avoid during Transcatheter Aortic Valve Implantation: Case Report

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