• Three hundred seventeen patients who had femorofemoral bypass surgery were examined for postoperative vascular changes that developed in the donor limb. "Unmasked" claudication developed in 7%, new claudication related to a "steal" developed in 3.5%, progression of preoperative claudication developed in 1%, new rest pain developed in 1.7%, and new necrosis developed in 0.7% of patients. Postoperatively, the donor limb ankle-brachial index decreased 0.30 or greater in 3% of the patients, decreased 0.15 to 0.29 in 6%, and decreased 0.10 to 0.14 in 6% of the patients. Only eight patients (3%) had a clinical and hemodynamic steal. Late vascular procedures for donor iliac stenosis were few, resulting in an iliac percutaneous transluminal angioplasty in 3% and inflow bypasses in 3%. Angiographic patterns of donor and recipient limbs were not predictive of "clinical" or "hemodynamic" steal events. Most new donor limb symptoms of claudication were an unmasking of arterial insufficiency previously present in the donor limb that became apparent when the recipient limb was improved.
(Arch Surg. 1991;126:681-686)