Donor limb vascular events following femoro-femoral bypass surgery. A Veterans Affairs Cooperative Study
Three hundred seventeen patients who had femorofemoral bypass surgery were
examined for postoperative vascular changes that developed in the donor
limb. "Unmasked" claudication developed in 7%, new claudication related to
a "steal" developed in 3.5%, progression of preoperative claudication
developed in 1%, new rest pain developed in 1.7%, and new necrosis
developed in 0.7% of patients. Postoperatively, the donor limb
ankle-brachial index decreased 0.30 or greater in 3% of the patients,
decreased 0.15 to 0.29 in 6%, and decreased 0.10 to 0.14 in 6% of the
patients. Only eight patients (3%) had a clinical and hemodynamic steal.
Late vascular procedures for donor iliac stenosis were few, resulting in an
iliac percutaneous transluminal angioplasty in 3% and inflow bypasses in
3%. Angiographic patterns of donor and recipient limbs were not predictive
of "clinical" or "hemodynamic" steal events. Most new donor limb symptoms
of claudication were an unmasking of arterial insufficiency previously
present in the donor limb that became apparent when the recipient limb was
improved.
