'Trash foot' following operations involving the abdominal aorta.

BACKGROUND

Acute lower limb ischaemia following aortic surgery is commonly termed 'trash foot'. The exact cause of the ischaemia is unknown, but it has been attributed to athero-emboli from native arteries, thrombo-emboli from any prosthetic graft or thrombosis of small vessels in the distal arterial tree.

METHODS

Review of 1601 aortic reconstructions performed between 1976 and 1995.

RESULTS

'Trash foot' occurred in 32 patients (44 limbs): 23 cases followed aortic aneurysm repair and nine cases followed an aorto-femoral bypass for occlusive disease. Six cases of 'trash foot' (13.6%) underwent an early amputation (one above-knee, two below-knee and three cases of amputation of one or more toes) while a further nine cases (20.5%) underwent a delayed amputation (four above the knee, two below the knee and three cases of toe amputation). Eight patients (25%) with 'trash foot' died within 30 days of surgery.

CONCLUSION

'Trash foot' following aortic surgery is an unwelcome complication that is associated with a high morbidity and mortality. Attempts to reduce the incidence involve early mobilization and clamping of the iliac arteries, and irrigation of the aortic anastomosis and graft with heparin saline solution.