Anterior Abdominal Wall Necrosis Following Bypass for Aortoiliac Occlusive Disease

Abstract

An uncommon complication of ipsilateral anterior abdominal wall ischemic necrosis ("trash abdominal wall"), following microembolic occlusion of a unilateral patent internal iliac artery and collaterals during aortobifemoral bypass for aortoiliac disease, is presented. Recognition of the presence or lack of a collateral system from lateral thoracic and intercostal arteries to branches of the superficial epigastric on preoperative angiogram and its role in the perfusion of the anterior abdominal wall is stressed. Preserving both or at least one internal iliac artery and avoiding microembolism from endarterectomy will minimize the risk for this complication.