The importance of abdominal wall collateral blood vessels. Planning incisions and obtaining arteriography.

While several patterns of collateral blood flow around aortoiliac obstruction exist, the thoracic to lower-extremity pathway is often unrecognized. The principal blood vessels involved in this network are the internal mammary, superior epigastric, intercostal, inferior epigastric, and external iliac arteries. Two patients with aortoiliac occlusion experienced precipitation of rest pain because of transverse abdominal incisions for nonvascular procedures. Femoral anatomy was demonstrated arteriographically in two other patients by injection of contrast medium into the aortic arch. Patients with lower-extremity peripheral vascular disease may suffer exacerbation of their symptoms if the thoracic to lower-extremity collateral pathway is divided by poorly planned abdominal incisions. Ascending aortic or subclavian angiography is useful in some patients to define femoral arterial anatomy.