Iatrogenic thrombosis of the deep inferior epigastric artery during diagnostic angiography—a rare complicating factor during rectus free flap harvest

Christopher G. Langhammer, MD, PhD; Nathan F. Miller, MD; Carl L. Herndon, MD; Allen P. Burke, MD; Rishi Kundi, MD; Raymond A. Pensy, MD

Journal of Vascular Surgery Cases and Innovative Techniques (Dec 2022)

Iatrogenic thrombosis of the deep inferior epigastric artery during diagnostic angiography—a rare complicating factor during rectus free flap harvest

Christopher G. Langhammer, MD, PhD,
Nathan F. Miller, MD,
Carl L. Herndon, MD,
Allen P. Burke, MD,
Rishi Kundi, MD,
Raymond A. Pensy, MD

Affiliations

Christopher G. Langhammer, MD, PhD: Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD; Correspondence: Christopher G. Langhammer, MD, PhD, Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 South Greene St, Baltimore, MD 21201
Nathan F. Miller, MD: Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
Carl L. Herndon, MD: Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
Allen P. Burke, MD: Department of Pathology, University of Maryland Medical Center, Baltimore, MD
Rishi Kundi, MD: Division of Vascular Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD
Raymond A. Pensy, MD: Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD

Journal volume & issue: Vol. 8, no. 4
pp. 580 – 582

Abstract

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We describe a 28-year-old man who sustained an open IIIB left ankle fracture dislocation with heel pad avulsion. The patient underwent formal angiography of the left lower extremity, followed by free tissue transfer of a rectus abdominis flap several days later. Intraoperatively, a thrombus was identified in the deep inferior epigastric artery above the femoral artery access site requiring thrombectomy. Histologic analysis estimated the thrombus age at 12 to 72 hours, raising concern that the thrombus was induced during angiogram instrumentation. Donor and recipient site-specific risks of arterial instrumentation (including invasive diagnostics) should be considered when planning free tissue transfer.

Published in Journal of Vascular Surgery Cases and Innovative Techniques

ISSN: 2468-4287 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Surgery; Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: https://www.sciencedirect.com/journal/journal-of-vascular-surgery-cases-innovations-and-techniques

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