Emergency ligation of the external iliac artery

During a 19-year period, 35 of 1526 renal transplant operations were complicated by gross hemorrhage from infected arteriotomies. In 13 patients the common or external iliac artery was ligated and resected without immediate reconstruction for arterial continuity. There was no mortality from this procedure, and there was no limb loss. Early signs and symptoms of arterial insufficiency were rapidly reversed in most patients. Six patients, presently alive and 4-10 years after iliac artery ligation, were subjected to follow-up examinations of their distal circulation. One hemodialysis patient had slight symptoms of intermittent claudication, while the others were totally free of symptoms during daily activities. All patients had adequate distal arterial blood pressures. Postischemic maximal blood flows, obtained in three patients, were only slightly decreased. It is concluded that, for control of massive hemorrhage from infected arteriotomies in renal transplant patients, the iliac arteries can safely be ligated without immediate arterial reconstruction. The risk of limb loss is little but necessitates optimal postoperative support of the patient and close surveillance for early detection of irreversible arterial insufficiency.