Renal-Splanchnic Steal Syndrome: The Treatment of Chronic Mesenteric Ischemia With Renal Angioplasty and Stenting

Abstract

The clinical syndrome of chronic mesenteric ischemia classically presents with a combination of involuntary weight loss, post prandial abdominal pain, and food fear. With occlusion or stenosis of the celiac and superior mesenteric arteries (SMA) collateral blood flow between mesenteric vessels is common and frequently act as the sole blood supply to the intestine. We present a rare case of chronic mesenteric ischemia in which the main blood supply to the celiac and SMA were collaterals coming off the right renal artery resulting in renal-splachnic steal. After an unsuccessful attempt to cannulate the SMA and celiac vessels it was possible to relieve this patient’s symptoms with renal artery stenting.

Keywords

chronic mesenteric ischemia renal-splachnic steal syndrome Alfidi’s syndrome

Get full access to this article

View all access options for this article.

References

Hansen KJ , Wilson DB , Craven TE , et al. Mesenteric artery disease in the elderly. J Vasc Surg. 2004;40:45-52.

Sivamurthy N. , Rhodes J. , Lee D. , Waldman DL , Green RM , Davies MG Endovascular versus open mesenteric revascularization immediate benefits do not equate with short-term functional outcomes. J Am Coll Surg. 2006;202:859-867.

Alfidi RJ , Filson EJ , Frahlich ED , Gifford RW , Meaney TF Renal spanchnic steal. Cleave Clin Q. 1967 ;34:43-53.

Rosenbusch G. , van Douveren W. , Penn W. , de Vries P. , Kuypers P. Reno-coeliac steal phenomenon: in inferior phrenic and supra-renal as collaterals for the celiac trunk. Rofo. 1975;122:218-224.

Cornet A. , Barbier JP , Cassaigne JY Mesenteric arteries. Anastomotic blood supply of the mesentery via the renal and adrenal, without hypertension. Sem Hop. 1981;57: 1673-1676.

Hietala SO , Kunz R. Collateral circulation in stenosis or occlusion of the renal artery. Cardiovasc Radiol. 1979;2: 249-255.

Allen RC , Martin GH , Rees CR , et al. Mesenteric angioplasty in the treatment of chronic mesenteric ischemia. J Vasc Surg. 1996;24:415-423.

Sharafuddin M. , Olson C. , Sun S. , Kresowik T. , Corson J. Endovascular treatment of celiac and mesenteric arteries stenoses: application and results. J Vasc Surg. 2003;38: 692-698.

Brown D. , Schermerhorn M. , Powell R. , et al. Mesenteric stenting for chronic mesenteric ischemia. J Vasc Surg. 2005;42:268-274.

10.

Matsumoto A. , Angle J. , Spinosa D. , et al. Percutaneous transluminal angioplasty in the treatment of chronic mesenteric ischemia. Results and longterm followup . J Am Coll Surg. 2002;194(1 suppl):S22-S31.

11.

Steinmentz E. , Tatou E. , Favier-Blavoux C. , et al. Endovascular treatment as a first choice in the treatment of chronic intestinal ischemia . Ann Vasc Surg. 2002;16: 639-699.

12.

Sivamurthy N. , Surowiec SM , Culakova E. , et al. Divergent outcomes after percutaneous therapy for symptomatic renal artery stenosis. J Vasc Surg . 2004;39:565-574.

13.

Cho JS , Carr JA , Jacobsen G. , Shephard AD , Nypaver TJ , Reddy DJ Long term outcomes after mesenteric artery reconstruction: a 37-year experience . J Vasc Surg. 2002;35: 453-460.

14.

Park WM , Cherry KJ , Chua HK , et al. Current results of open revascularization for chronic mesenteric ischemia. A standard for comparison. J Vasc Surg. 2002;35:853-859.

15.

Mateo RB , O’Hara PJ , Nertzer NR , Mascha EJ , Beven EG , Krajewski LP Elective surgical treatment of symptomatic chronic mesenteric occlusive disease: early results and late outcomes. J Vasc Surg. 1999;29: 821-832.

16.

Cunningham CG , Reilly LM , Rapp JH , Schneider PA , Stoney RJ Chronic visceral ischemia. Three decades of progress. Ann Surg. 1991;214:415-423.

17.

Silva J. , White C. , Collins T. , et al. Endovascular therapy for chronic mesenteric ischemia. J Am Coll Cardiol. 2006;47:944-950.