Local Regulation of Blood Flow and the Occurrence of Edema after Arterial Reconstruction of the Lower Limbs

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Abstract
The relation between edema after arterial reconstruction of the lower limbs and various potential etiologic factors, including disturbances in local blood flow regulating mechanisms, was investigated in 22 patients with occlusive arterial disease. The occurrence of edema was unrelated to the severity of symptoms as well as to the perioperative changes in distal arterial blood pressure. Postreconstructive edema developed independently of postreconstructive hyperemia and of disturbances in the local vasoconstrictor response to increased venous pressure. The decisive factor for development of edema was the extensive dissection in the thigh and in the popliteal region required for femoropopliteal bypass surgery. Edema developed after 9 of 9 femoropopliteal bypass operations, and only after 1 of 12 reconstructions in the aorto-iliac or in the profound femoral segments (P = 0.001). The postreconstructive edema is a lymphedema due to surgical trauma, rather than the result of microvascular derangement.