Hypogastric and lumbar artery bypasses to restore gluteal perfusion after open aortoiliac aneurysm repair

Gluteal ischemia is a rare but often fatal complication after open abdominal aortic aneurysm repair. A 67-year-old man with an aortoiliac aneurysm presented with a patent right internal iliac artery (IIA) and an occluded left IIA. A bifurcated graft replacement was performed with both limbs of the graft anastomosed to the external iliac arteries. The right IIA was ligated and the inferior mesenteric artery was reimplanted. Postoperatively, the patient developed right gluteal ischemia. Hypogastric and lumbar artery bypasses were immediately performed and the patient recovered without gait disturbance. This treatment prevented potentially fatal necrosis of the buttock.