JOURNAL OF VASCULAR SURGERY Volume 18, Number 3 Meet&J abstracts 535

procedure, extent of profundaplasty, or postoperative change in ankle-brachial index.

Subsequently 22 operations were required in 17 limbs with a mean time to initial failure of 11 months (range 0 to 40 months). The additional procedures performed included four inflow; 10 outflow; four inflow and outflow; two inflow and profimdaplasty; and two isolated profunda- plasty. No major amputations were required in the 30-day perioperative period. Major amputations were required in two limbs, one below-knee amputation at 5 months and one above-knee amputation at 6 months, both occurring in patients who had failed subsequent femoral-tibial bypasses. No amputations were required after isolated profknda- plasty. Only one of six isolated profundaplasty limbs required a subsequent operation, however, because of the small size of this group, no statistical analysis was per- formed.

In contrast to our previous series of profundaplasties in a similar patient population from 1971 to 1979, this study shows a lower percentage of isolated proftmdaplasties (9% vs 29%), a higher incidence of subsequent operation for arterial insufficiency, and a higher limb salvage rate (96% vs 58% at 4 years). We attribute these differences to the advances in the technical success of distal arterial bypass. Isolated profundaplasty can give good results in a select group of patients. Profundaplasty in conjunction with other procedures remains an important adjunct in lower limb revascularization, allowing for a high rate of limb salvage in patients with severe vascular occlusive disease.

Groin lymphatic complications following arterial re- construction Steve H. Tynall, MD, Alexander D. Shepard, MD, Judy Wilczewski, RN, BSN, Daniel J. Reddy, MD, J. I?. Elliott, Jr., MD, and Calvin B. Ernst, MD, Henly Ford Hospital, Detroit, Mich.

Groin lymphatic complications (GLC) are a rare but potentially serious problem after arterial reconstruction. Over the last 15 years from a total of 2679 arterial operations requiring groin incisions, 41 GLC (1.5%) were recognized. There were 28 lymphocutaneous fistulas (LF) and 13 lymphoceles. There was no significant difference in GLC after primary operations compared with secondary operations (p = 0.298). The highest incidence of GLC was in patients undergoing aortobifemoral bypass for aneurys- mal disease (8.1%) and in those undergoing isolated femoral procedures in a previously operated groin (5.3%). The lowest frequency of GLC followed femoral-distal bypass with a venous conduit (0.6%). Diabetes, obesity, method of skin closure, and type of graft material were not predictive of a GLC. Nonoperative treatment of LF consisting of bed rest, antibiotics, and aggressive local wound care was attempted in 18 patients (64%). Operative therapy with wound exploration, attempted identification and control of the leak site, and meticulous wound closure was used in 10 patients (36%). Infectious wound compli- cations with one resultant graft infection developed in 5 of 18 patients with LF who did not undergo operation. There were no wound or graft infections in the LF patients treated with operation. Lymph fistulas in patients undergoing repeat operation within 2 days of diagnosis resolved sooner than in patients in whom repeat operation was delayed more than 2 days (median 3 versus 19.5 days). Operative exploration of lymphoceles did not reduce hospital stay or infectious wound complications. Repet- itive lymphocele aspirations did not affect rapidity of resolution or increase the infectious complications. It is concluded that GLC remain a troublesome complication of arterial reconstruction, early reoperation should be performed once a LF is diagnosed, and treatment for lymphoceles should be individualized, with neither op- erative nor nonoperative management showing clear su- periority.