Study of venous and lymphatic components in the production of edema following femoropopliteal by-pass. A comparative scintigraphy and radiologic study.

Fifteen consecutive patients who underwent femoro-popliteal reconstructions were examined comparatively by X-Ray and radionuclide lymphograms during the first postoperative week. The role of venous and lymphatic involvement and the significance of the surgical technique on the presence and extent of the postoperative edema was investigated. Patients were grouped according to the graft material (saphenous vein vs. PTFE), and the site of distal anastomosis. Edema developed in all but one patient, being more prominent in those with a saphenous graft with the popliteal anastomosis below the knee. Phlebography confirmed venous obstruction in one case. Contrast and scintigraphic lymphograms disclosed several degrees of lymphatic damage (disruption of the vessels and extravasation) in all instances, which correlated with the extent of surgical dissection and the development of postoperative edema. There was good agreement between the two lymphatic imaging techniques.