Abstract
A 56-year-old man presented with intermitted lower extremity claudication (after walking about 500 meters). On examination, his right femoral artery was palpable, while the popliteal artery and more distal peripheral arteries were not palpable. The peripheral arteries of the left lower extremity were palpable throughout. Using photoelectric plethysmography, a pulse wave was recorded in the left third toe, but not in the right. Angiography demonstrated a complete occlusion of the right femoral artery as well as a complete occlusion of the left common iliac artery with well developed colleteral blood flow in the pelvic region. We performed a right fomoro-popliteal bypass grafting with an in-situ saphenous vein. The postoperative course was uneventful. A postoperative angiogram indicated good patency of the graft. There have been no signs or symptoms of ischemia in the left lower extremity.
The finding of complete occlusion of the left common iliac artery without ischemic symptoms or signs due to well developed collateral blood flow was very interesting. Though the limb-threatening ischemia by interruption of critical collaterals during nonvascular operation is a rare occurrence, the recognition and appropriate management of this occurrence in patients with arteriosclerosis obliterans should minimize the morbidity of this unusual but serious complication.
