Albumin kinetics and oedema following reconstructive arterial surgery of the lower limb

Of 26 patients who had either femoro-popliteal or aorto-iliac bypass surgery pitting oedema occurred in the reconstructed limb during the post-operative period in 13. Eleven of 13 patients (84.6%) who had a femoro-popliteal bypass developed oedema compared to 2 of 13 (15.4%) who had aorto-iliac operations (P less than 0.001 chi squared). There was a significant reduction in the serum concentration of total protein and the albumin fraction after operation in both groups of patients (P less than 0.01). The concentration of protein and albumin remained lower than the pre-operative values until the end of the study period but the mean values did not at any stage fall below the lower limit of the normal range. Albumin labelled with I125 was used to investigate changes in the albumin content of the reconstructed limbs. Following femoro-popliteal bypass there was a three fold increase in I125 albumin compared to the non-operated limbs and this persisted to the end of the study period (P less than 0.001). After aorto-iliac surgery there was only a small transient accumulation of I125 albumin in the legs compared to the pre-operative value (P less than 0.02). In both groups of patients large accumulations of albumin were associated with the presence of pitting oedema. It was concluded that altered albumin kinetics play an important part in the development of post-reconstruction oedema. The possible mechanisms involved are discussed together with the practical implications of the results.