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 artery may be an important pathway for collateral blood supply to the lower extremities. 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 blood flow should be evaluated noninvasively. In the setting of reversed flow, the inferior epigastric artery usually should not be divided.