Nathan W. Kugler

Objectives: Combined aneurysmal and occlusive disease presents a challenging clinical problem often treated with a hybrid combined open and endovascular approach. Gluteal compartment syndrome is a rare but serious complication following vascular surgical intervention. Methods: We present the case of a 77-year-old man who underwent hybrid repair of an iliac aneurysm and chronic limb-threatening ischemia with associated rest pain. Following an uneventful repair, in the early postoperative period, he developed severe left buttock pain with an isolated lactic acidosis and elevated creatine kinase. He was expeditiously diagnosed with left gluteal compartment syndrome and underwent operative exploration with fasciotomy and subsequent delayed primary closure. Results and Conclusions: Gluteal compartment syndrome is a rare complication of hybrid iliac artery repair; however, early recognition and treatment may avoid the potential long-term morbidity. The patient in this case presentation recovered uneventfully and was shown to have complete aneurysmal exclusion with resolution of his occlusive symptoms.

Common femoral artery disease is at the heart of nearly all treatment algorithms and decisions for patients with symptomatic peripheral arterial disease. Surgical endarterectomy has been the mainstay of common femoral treatment with a wealth of data supporting its safety, efficacy, and durability. Advances in endovascular technology and techniques for the management of iliac and superficial femoral artery disease has resulted in a paradigm shift in management. The common femoral artery has been aptly named a “no stent zone” due to anatomic and disease-specific challenges that have limited the role for endovascular techniques. New technology and techniques in the endovascular management of common femoral disease seek to change our treatment strategies. A multimodal approach utilizing a combination of angioplasty, atherectomy, and stenting has been shown most beneficial, although limited long-term data leave durability an unanswered question. While surgical treatment remains the gold standard, advances in the endovascular approach will certainly continue to improve outcomes. As truly isolated common femoral disease is a rarity, a collaborative approach combining all benefits of open and endovascular techniques in the treatment of peripheral arterial disease is essential. The authors have no potential conflicts of interest to disclose. Article published online: 16 June 2023 © 2023. Thieme. All rights reserved. Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

Objectives: Axillary pullout syndrome is a complex, potentially fatal complication following axillary-femoral bypass graft creation. The re-operative nature, in addition to ongoing hemorrhage, makes for a complicated and potentially morbid repair. Methods: We present the case of a 57-year-old man with history of a previous left axillary-femoral-femoral bypass who presented with acute limb-threatening ischemia as a result of bypass thrombosis managed with a right axillary-femoral bypass for limb salvage. His postoperative course was complicated by an axillary anastomotic dehiscence while recovering in inpatient rehabilitation resulting in acute, life-threatening hemorrhage. He was managed utilizing a novel hybrid approach in which a retrograde stent graft was initially placed across the anastomotic dehiscence for control of hemorrhage. He then underwent exploration, decompression, and interposition graft repair utilizing the newly placed stent graft to reinforce the redo axillary anastomosis. Results and Conclusion: Compared with a traditional operative approach, the hybrid endovascular and open approach limited ongoing hemorrhage while providing a more stable platform for repair and graft revascularization. A hybrid approach to the management of axillary pullout syndrome provides a safe, effective means to the management of axillary anastomotic dehiscence while minimizing the morbidity of ongoing hemorrhage.