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Planning Incisions and Obtaining Arteriography

William C. Krupski, MD; Ahimsa Sumchai, MD; David J. Effeney, MB, BS, FRACS; William K. Ehrenfeld, MD

Arch Surg. 1984;119(7):854-857.

Abstract
• While several patterns of collateral blood flow around aortoiliac obstruction exist, the thoracic to lower-extremity pathway is often unrecognized. The principal blood vessels involved in this network are the internal mammary, superior epigastric, intercostal, inferior epigastric, and external iliac arteries. Two patients with aortoiliac occlusion experienced precipitation of rest pain because of transverse abdominal incisions for nonvascular procedures. Femoral anatomy was demonstrated arteriographically in two other patients by injection of contrast medium into the aortic arch. Patients with lower-extremity peripheral vascular disease may suffer exacerbation of their symptoms if the thoracic to lower-extremity collateral pathway is divided by poorly planned abdominal incisions. Ascending aortic or subclavian angiography is useful in some patients to define femoral arterial anatomy.

(Arch Surg 1984;119:854-857)

Author Affiliations
From the Departments of Surgery, University of California (Drs Krupski, Sumchai, Effeney, and Ehrenfeld) and Veterans Administration Medical Center (Drs Krupski and Effeney), San Francisco.

Footnotes
Accepted for publication Jan 9, 1984.

Reprint requests to Surgical Service (112G), Veterans Administration Medical Center, 4150 Clement St, San Francisco, CA 94121 (Dr Krupski).

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