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

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."