Regional ischemia due to compromised collateral circulation after arterial reconstruction

Two cases of severe regional ischemia following aorto-femoral-popliteal vascular reconstruction are presented. Partial necrosis of the gluteal musculature occurred in one of the patients. Total necrosis of the proximal part of the thigh and the gluteal region developed in the other patient, despite preserved blood supply to the distal part of the leg. The available literature contains no previous reports of necrosis of musculature and skin from such cause. On the basis of these cases, the importance of preserving the pelvic-femoral collaterals, viz. rectal artery anastomosis and Hunterian anastomosis, is emphasized. Sufficient pelvic-femoral collaterals presumably account for the low incidence of gluteal claudication following aortofemoral bypass surgery.