Interruption of critical aortoiliac collateral circulation during nonvascular operations: a cause of acute limb-threatening ischemia.
In patients with aortoiliac occlusive disease interruption of critical collaterals during another nonvascular or cardiac operation may threaten limb viability. This occurred in four patients whose limb-threatening ischemia was precipitated by radical cystectomy with bilateral hypogastric artery ligation, left colon resection, or coronary artery revascularizations by means of the internal mammary artery. Important collateral pathways, the interruption of which may account for this phenomenon, are detailed, and approaches are outlined for prevention and management of acute ischemia in this setting.
Dietzek
A M
AM
Division of Vascular Surgery, Montefiore Medical Center-Albert Einstein College of Medicine, New York.
Goldsmith
J
J
Veith
F J
FJ
Sanchez
L A
LA
Gupta
S K
SK
Wengerter
K R
KR
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000502:physiology*; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000000981:diagnostic imaging; D003097:Collateral Circulation / Q000502:physiology*; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000502:physiology*; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013514:Surgical Procedures, Operative / Q000009:adverse effects*