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Case 106: Arteriopath

A 50 year old man is being investigated for poorly controlled hypertension. He is a smoker, hypertensive, dyslipidaemic and also has peripheral vascular disease. The radiologists notes an incidental finding.

1. What is the study and the anatomic abnormality?

This is an aortic digital subtraction angiogram. The pigtail injection catheter can be seen located in the proximal aorta. The renal arteries are well demonstrated. The abnormality is a large inferior mesenteric artery that flows into a dilated marginal artery of Drummond and then into the proximal superior mesenteric artery to supply the midgut. This is the "wandering artery of Drummond".

2. What is the underlying cause for this finding?

Chronic occlusion of the proximal superior mesenteric artery leads to development of this substantial collateral vessel. Failure to recognise this anatomic abnormality at operation can have disasterous results if the IMA is ligated during surgery on the left colon. This may lead to infarction of the SMA territory of bowel.

Clinical interest of digestive arterial trunk anastomoses.