Department of Vascular and Endovascular Surgery, Ramón y Cajal's University Hospital, Madrid, Spain.
Department of Vascular and Endovascular Surgery, Ramón y Cajal's University Hospital, Madrid, Spain.
Ann Vasc Surg. 2021 Jan;70:444-448. doi: 10.1016/j.avsg.2020.06.025. Epub 2020 Jun 24.
The presence of sac enlargement after abdominal aortic aneurysm (AAA) open repair, a condition usually called perigraft seroma (PGS), nearly always has a benign behavior. Some theories implicated for PGS formation include coagulation abnormalities, fibroblast inhibition, low-grade infection, or improper graft handling.
This is a retrospective study including patients treated for AAA in 2 academic vascular surgery departments from 2007 to 2014, where 1 center preferably used polytetrafluoroethylene (PTFE) grafts whereas the preference of other center was mostly Dacron graft. The definition of PGS was conceived as a fluid collection around the graft on CT scan imaging with a radiodensity ≤25 Hounsfield units, reaching at least 30 mm in diameter and beyond the third postoperative month. Analysis was performed between patients with and without PGS.
Seventy-eight patients met the inclusion criteria: 42 received Dacron and 36 PTFE grafts. Twenty-three (29.5%) patients accomplished the PGS diagnosis. Having a PTFE graft was the strongest factor for PGS formation on multivariate analysis. The medium seroma size was 42 mm (range, 30-90.6 mm) and the mean time from AAA repair to PGS detection was 26 months (range, 4-106 months). Three patients of the 23 with PGS required surgical repair, all of them were successfully treated: 2 by endovascular means and the remaining with explantation and Dacron reconstruction.
PGS formation is not an unusual complication after open reconstructions for AAA treatment. This is especially true for PTFE grafts, and thus, closer follow-up is warranted if using this material. Treatment is clearly needed when symptoms appear; however, preventive strategies with either endovascular relining or reopen reconstructions require an individual approach counterbalancing benefits versus risk of the procedures.
腹主动脉瘤（AAA）开放修复后出现囊扩大，这种情况通常称为移植物周围血清肿（PGS），几乎总是良性的。一些理论认为 PGS 的形成包括凝血异常、成纤维细胞抑制、低度感染或不当移植物处理。
这是一项回顾性研究，纳入了 2007 年至 2014 年在 2 个学术血管外科部门接受 AAA 治疗的患者，其中 1 个中心优选使用聚四氟乙烯（PTFE）移植物，而另一个中心的首选是大多数为膨体聚四氟乙烯（ePTFE）移植物。PGS 的定义是 CT 扫描成像中围绕移植物的液体聚集，其密度≤25 亨氏单位，直径至少达到 30 毫米，且超过术后第 3 个月。对有和无 PGS 的患者进行分析。
78 例患者符合纳入标准：42 例接受 ePTFE 移植物，36 例接受膨体聚四氟乙烯（ePTFE）移植物。23 例（29.5%）患者诊断为 PGS。多变量分析显示，使用 PTFE 移植物是 PGS 形成的最强因素。中位血清肿大小为 42 毫米（范围 30-90.6 毫米），从 AAA 修复到 PGS 检测的平均时间为 26 个月（范围 4-106 个月）。23 例有 PGS 的患者中有 3 例需要手术修复，均成功治疗：2 例采用血管内治疗，1 例采用移植物切除和 ePTFE 重建。
PGS 的形成在 AAA 治疗的开放重建后并不是一种罕见的并发症。对于 PTFE 移植物尤其如此，如果使用这种材料，需要更密切的随访。当出现症状时，显然需要治疗；然而，无论是血管内再衬还是再次开放重建的预防策略，都需要根据具体情况权衡手术的获益和风险。
