Secondary arterial repair. The management of late failures in reconstructive arterial surgery.

The incidence and success of secondary operations after reconstructive arterial surgery were studied in a series of 4,247 cases of aneurysmal and occlusive arterial disease. Postoperative complications requiring secondary operations occurred, in order of frequency, as the result of defective healing (including infection), deterioration of the arterial implant, and degenerative arterial changes in the site of surgical intervention. A large variety of surgical techniques were used for correction, such as total replacement, segmental resection and replacement, remote bypass, thrombectomy, and partial excision and reanastomosis. Wth the exception of complications due to infection, the results of repair were good in 60% to 90% of the various categories; only 40% of the infected grafts could be managed without the loss of life or limb. The results appear to justify the trend noted in recent years to a more aggressive use of secondary, salvage operations.