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Axillary pullout syndrome: A novel approach to managing a devastating complication
Nathan W Kugler1, Brian D Lewis1, Michael Malinowski1
1Division of Vascular and Endovascular Surgery, 5506Medical College of Wisconsin, Milwaukee, WI, USA.
Vascular
|September 28, 2021
Summary
Axillary pullout syndrome, a severe complication of axillary-femoral bypass, can be safely managed with a hybrid approach. This method combines endovascular and open techniques to control hemorrhage and reinforce the anastomosis.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Surgical Complications
Background:
- Axillary-femoral bypass grafts are used for limb salvage but can lead to serious complications.
- Axillary pullout syndrome, characterized by anastomotic dehiscence and hemorrhage, presents a significant surgical challenge.
Observation:
- A 57-year-old male with prior bypass experienced acute limb ischemia due to thrombosis, necessitating a new bypass.
- Postoperatively, he developed axillary anastomotic dehiscence with life-threatening hemorrhage.
Findings:
- A novel hybrid approach was employed, initially using a retrograde stent graft to control bleeding.
- Subsequent open exploration, decompression, and interposition graft repair reinforced the anastomosis using the stent graft.
Implications:
- The hybrid approach effectively controlled hemorrhage and provided a stable platform for complex axillary anastomosis repair.
- This strategy offers a safe and effective alternative to traditional open repair for axillary pullout syndrome, minimizing morbidity.
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