A singular case of iatrogenic axillofemoral bypass disruption: a dramatic event treated by a lucky combined approach

Proximal disruption of an axillofemoral bypass is a catastrophic event rarely caused by a posttraumatic anterior dislocation of the shoulder. Herein, we present a 74-year-old man with a painful dislocation of the right shoulder that was successfully reduced. Three hours later he had hemodynamic shock with an expanding and pulsating hematoma at the level of the right shoulder, pectoral and infraclavicular region. Surgical exposure of the right brachial artery was carried out, and intraoperative angiography revealed a proximal anastomotic leakage. The distal ballooning improved the hemodynamic status, and by a redo infraclavicular incision the hematoma was drained. The arterial leak was repaired by an 8 mm polytetrafluoroethylene interposed graft between the axillary artery and existing graft. The utility of a combined approach (endovascular + open surgical) is discussed.