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Axillary pullout syndrome: A novel approach to managing a devastating complication. Vascular 2022 Dec;30(6):1189-1191



Pubmed ID




Scopus ID

2-s2.0-85116074410 (requires institutional sign-in at Scopus site)


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.

Author List

Kugler NW, Lewis BD, Malinowski M


Brian D. Lewis MD Professor in the Surgery department at Medical College of Wisconsin
Michael Malinowski MD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Anastomosis, Surgical
Arterial Occlusive Diseases
Middle Aged
Vascular Surgical Procedures