Local complications following surgical treatment of lower limb atherosclerosis

654 arterial reconstructions for lower limb atherosclerosis were performed during the period January 1967-April 1975. Ten significant infections were seen in the material. Necrosis of the wound edges was observed in 20 limbs. Marked oedema was noticed in 148 limbs, most after femoro-popliteal repair. Forty-two early reocclusions (6.4%) and 39 haemorrhagic complications (5.9%) were observed. About 2/3 of these cases were successfully reoperated with reestablished circulation. Immediate exploration of the reconstructed arterial segment is therefore justified when such complications occur in the early postoperative period. Most early reocclusions were due to insufficient endarterectomy, mostly performed by ringstripping. Ringstripping between two arteriotomies and a better intraoperative control of the endarterectomized arterial segment might have prevented some of these reocclusions. When bleeding occurred in the early postoperative phase local repair was usually successful. Haemorrhage occurring later in the postoperative period had a poorer outcome. As they are often related to infection, such cases should be treated by ligation of the artery and a by-pass through an uninvolved area if the limb is threatened.