# An Unusual Presentation of Inferior Mesenteric Artery Steal Syndrome Induced by Walking

## TL;DR

A rare case of abdominal pain caused by blood flow redirection from the intestines to the legs during walking is described and successfully treated.

## Contribution

This paper reports a rare clinical case of inferior mesenteric artery steal syndrome triggered by walking and highlights its successful surgical treatment.

## Key findings

- A 77-year-old woman experienced abdominal pain due to mesenteric ischemia caused by IMA steal during walking.
- Aortobifemoral bypass surgery resolved her symptoms, confirming the diagnosis.
- This case underscores the importance of considering IMA steal syndrome in patients with walking-induced abdominal pain.

## Abstract

Aortoiliac occlusive disease results in varying degrees of pelvic and lower extremity arterial insufficiency. Disease limited to the infrarenal segment does not typically affect intestinal perfusion in the absence of visceral aortic or mesenteric vessel involvement. We report a rare case of a 77-year-old woman who presented with severe and incapacitating abdominal pain triggered by walking short distances (approximately 20 yards). Computed tomography angiography demonstrated that the coeliac and superior mesenteric arteries were patent, but the infrarenal aorta and both common iliac arteries were occluded. Collaterals from the inferior mesenteric artery (IMA) supplied the lower limbs. The abdominal pain was thought to be due to the arterial supply to her legs from the diverting mesenteric blood flow to supply the lower limbs, resulting in mesenteric ischemia when walking. The patient underwent a successful aortobifemoral bypass, which resulted in the resolution of her abdominal symptoms. IMA steal has rarely been reported in the literature, and vascular surgeons should be aware of this unusual differential diagnosis for "abdominal pain on walking."