Hemorrhage and thrombosis as early complications of femoropopliteal bypass grafts: Causes, treatment, and prognostic implications

The experience with 140 cases of early hemorrhage or graft thrombosis after femoropopliteal bypass arterial reconstruction at the Massachusetts General Hospital is reviewed. Postoperative hemorrhage occurred in one of two patterns. The first was bleeding within the first 24 hours secondary to technical aspects of the reconstruction and unrelated to sepsis. Re-exploration and local repair resulted in early patency in 88 percent of patients with an eight percent mortality rate. The second pattern was bleeding within 3 to 28 days. This was always related to sepsis. The only effective treatment was ligation of the involved vessels and grafting through an uninvolved route. All attempts at local repair resulted in recurrent bleeding. Early thrombosis occurred in 98 grafts. Surgically correctable causes were discovered in two thirds. Graft revision was performed on 66 patients with two deaths. At discharge, 48 grafts (73 percent] remained patent. Best long-term patency rates were obtained when correctable problems were discovered at re-exploration. Compared with results of uncomplicated reconstruction, the prognosis is poor for patency of grafts that require re-exploration for acute complications, even when revision is successful. Nevertheless, many limbs may be salvaged with proper management.