Lower limb oedema after arterial reconstructive surgery. Influence of preoperative ischaemia, type of reconstruction and postoperative outcome.

To investigate the early limb oedema after various types of arterial reconstructions 180 patients operated on due to occlusive or aneurysmatic arterial disease were followed by daily circumference measurements of the lower leg. For volume calculations circumference measurements were shown to be well correlated to water displacement volumetry. Femoro-popliteal bypass resulted regularly in a pronounced oedema, significantly more than in any of the other groups. Aortofemoral reconstruction did not lead to significant leg oedema, but all other reconstructions resulted in a volume increase in the symptomatic leg. Following distal reconstruction, patients with popliteal aneurysm and no ischaemia developed the same maximal volume increase as patients with severe ischaemia. Regarding all patients as one group the volume increase was not significantly correlated to the preoperative ankle blood pressure or ankle brachial pressure index. Only after various proximal reconstructions, with a limited postoperative oedema, there was a correlation between the degree of preoperative ischaemia and postoperative volume increase. A successful reconstruction was not necessary for the development of postoperative oedema. A failed distal reconstruction was followed by a significant oedema, although less pronounced than after a successful. Exploration of the vessels without reconstruction also led to a postoperative oedema. The findings indicate that the pathogenesis of postreconstructive oedema is multifactorial. The type of reconstruction is the most important predictive factor and degree of preoperative ischaemia and success of operation are contributing factors.