Department of Vascular Surgery, Basel University Hospital, Spitalstrasse 21, 4031, Basel, Switzerland.
World J Surg. 2011 Apr;35(4):905-10. doi: 10.1007/s00268-010-0921-6.
Fluid around the graft in the original aneurysm sac after open abdominal aortic aneurysm (AAA) repair is a poorly researched phenomenon. If large, such perigraft seroma can cause symptoms of compression, and cases of rupture have even been described. We assessed whether endarterectomy of the aneurysm sac reduces the incidence of perigraft fluid and improves graft incorporation.
Starting in July 2005, all patients with elective open AAA repair were alternately treated either with conventional thrombectomy or thrombectomy plus endarterectomy of the aneurysm sac. All patients were treated with a polytetrafluoroethylene (PTFE) graft. The maximum axial width of the perigraft fluid collection was measured on computed tomography (CT) scans 1 year after operation.
The CT scans of 115 patients were available; 56 had endarterectomy of the aneurysm sac and 59 did not. Fluid collections were significantly smaller in patients with endarterectomy (median width 4.0 versus 8.0 mm; P = 0.0001). Eight patients with endarterectomy had a fluid collection wider than 10 mm compared to 28 patients without endarterectomy (OR 0.18, 95% CI 0.07-0.46). After endarterectomy, 17 patients had radiological signs of complete graft incorporation in comparison to only 6 patients without endarterectomy (OR 3.85, 95% CI 1.39-10.66). No patients were symptomatic or reoperated for perigraft seroma.
Endarterectomy of the aneurysm sac in open AAA repair appears to improve graft incorporation. The high rate of asymptomatic perigraft seroma is surprising, and its clinical significance is unknown. Ultrafiltration of PTFE grafts may be an underlying mechanism.
开放腹主动脉瘤（AAA）修复术后，移植物周围原始动脉瘤囊中存在液体是一个研究甚少的现象。如果体积较大，这种移植物周围血清肿可能会引起压迫症状，甚至有破裂的病例报道。我们评估了动脉瘤囊内膜切除术是否能降低移植物周围液体的发生率并改善移植物的融合。
从 2005 年 7 月开始，所有择期行开放 AAA 修复的患者均被交替采用传统血栓切除术或血栓切除术联合动脉瘤囊内膜切除术治疗。所有患者均接受聚四氟乙烯（PTFE）移植物治疗。术后 1 年，通过计算机断层扫描（CT）测量移植物周围液体收集的最大轴向宽度。
115 例患者的 CT 扫描结果可用；56 例患者行动脉瘤囊内膜切除术，59 例患者未行。内膜切除术患者的液体收集量明显较小（中位数宽度 4.0 毫米与 8.0 毫米；P = 0.0001）。8 例行内膜切除术的患者液体收集量大于 10 毫米，而 28 例未行内膜切除术的患者中只有 28 例（比值比 0.18，95%置信区间 0.07-0.46）。内膜切除术后，17 例患者有完全融合的影像学征象，而未行内膜切除术的患者中只有 6 例（比值比 3.85，95%置信区间 1.39-10.66）。没有患者出现移植物周围血清肿的症状或需要再次手术。
开放 AAA 修复术中的动脉瘤囊内膜切除术似乎可以改善移植物的融合。令人惊讶的是，大量无症状的移植物周围血清肿的发生率很高，其临床意义尚不清楚。PTFE 移植物的超滤可能是一个潜在的机制。
