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A 72-year-old woman presented with a several month history of increasing abdominal pain following eating and 15-pound weight loss. The aortagram showed no filling of the celiac or superior mesenteric arteries (see mid-abdominal vascular relationships.) There was a large meandering mesenteric artery (arc of Riolan) (see lower GI bleed, frame 2) arising from the inferior mesenteric and communicating with the superior mesenteric system.