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Peripheral vascular complication as a result of transgender reassignment surgery
Introduction
For most, gender assignment correlates with gender identity, which is an innate sense of maleness or femaleness. However, some have a gender identity that does not correlate with their assigned gender. Surgery represents the culmination of a long awaited transformative process in the lives of these patients. The operation requires a convergence of multiple surgical specialties working together to provide a distinctive result. However; this level of technically challenging surgery does not come without its complications. Vascular complications in particular pose a unique problem to these patients because vital anastomoses are necessary to provide adequate blood flow to their neophallus in case of female to male transformation.
Case Presentation
A 49 year old female to male transgender patient who underwent a phalloplasty with a left radial forearm free flap presented with new onset left leg debilitating claudication post-operatively. At the time of the transgender surgery an unsuccessful attempt was made to anastomose the free flap to the left superficial femoral artery (SFA) that was subsequently revised to an end to end anastomosis to the inferior epigastric artery. This alteration provided excellent perfusion to the neophallus however; a stenosis at the proximal SFA was later uncovered as a complication of the original anastomotic attempt. This stenosis was demonstrated on an office duplex and confirmed with an angiogram and subsequently corrected through the deployment of a Viabahn stent. The stent ameliorated the claudication of the patient.
Conclusion
As society continues to change, medicine must evolve alongside it in an effort to keep pace with the ever expanding practice of healthcare. Recent changes to the Center for Medicare and Medicaid allow for reimbursement of transgender procedures in seven states currently with more to follow, which allows us to conclude that the expansion of transgender medicine is on the horizon. These patients would benefit from having the surgical expertise of vascular surgeons considering that the vascular complications could prove to be detrimental to the success of phalloplasty grafts. As we improve our care for such a unique area of medicine we must continue to involve multiple surgical and medical perspectives, remembering that the best patient outcome must always come first.