Critical leg ischemia resulting from interruption of collaterals by harvest of the rectus abdominis free flap: Endovascular salvage

In the setting of aortoiliac occlusive disease, the inferior epigastric art ery may be an important pathway for collateral blood supply to the lower ex tremities. A 72-year-old man developed critical ischemia of both legs after harvest of a rectus abdominis free flap as a result of interruption of the inferior epigastric artery. In patients with aortoiliac occlusive disease, the contribution of the inferior epigastric artery to lower extremity bloo d flow should be evaluated noninvasively. In the setting of reversed flow, the inferior epigastric artery usually should not be divided.