Strategic Inferior Mesenteric Artery Revascularization for an Inferior Mesenteric Artery Aneurysm Associated with Chronic Occlusion of the Celiac and Superior Mesenteric Arteries.

INTRODUCTION: Inferior mesenteric artery (IMA) aneurysms are extremely rare visceral artery aneurysms and may develop secondary to chronic mesenteric occlusive disease. The optimal revascularization strategy remains controversial when both the celiac artery (CA) and superior mesenteric artery (SMA) are occluded. CASE PRESENTATION: A 75-year-old man with a 3.0-cm IMA aneurysm associated with chronic total occlusion of both the CA and SMA due to severe aortic calcification was referred to our institution. To minimize the risk of mesenteric ischemia during planned aortic surgery, a staged approach was adopted. Open repair was performed using a retrograde bypass from the left external iliac artery to the IMA with an 8-mm expanded polytetrafluoroethylene graft, followed by complete aneurysm resection. SMA revascularization was not performed because extensive calcification precluded endovascular intervention and alternative bypass procedures would have increased surgical complexity and invasiveness. Postoperative imaging demonstrated graft patency and preserved mesenteric perfusion through the arc of Riolan. CONCLUSIONS: Strategic isolated IMA revascularization may be a feasible option in selected patients with IMA aneurysms associated with chronic mesenteric occlusive disease when SMA revascularization is anatomically unsuitable. Long-term surveillance remains essential.