A hybrid technique for the management of bleeding from hostile irradiated groins: Obturator canal bypass and coil-embolization

Abstract

A hostile groin may preclude direct vascular reconstruction of the common femoral artery (CFA). Extra-anatomic bypass techniques, such as obturator canal bypass, can successfully be used to circumvent a hostile groin. We present a case of a 61-year old patient with a hostile groin due to radiation induced fibrosis and necrosis who presented at the emergency department with acute hemorrhage from the CFA. We performed an obturator canal bypass using a ringed 6 mm PTFE prosthesis followed by ligation of the external iliac artery and coil-embolization of remaining branches of the CFA through a retrograde approach from the popliteal artery. In the postoperative course no more bleeding occurred and the limb remained well perfused. A hybrid technique of obturator canal bypass, ligation of the external iliac artery and coil-embolization of common femoral artery side branches can be used to control acute hemorrhage in hostile groins.

Keywords

• Hostile groin
• Hemorrhage
• Extra-anatomic bypass
• Obturator bypass
• Radiation-induced fibrosis
• Coil embolization