Bleeding through the fiber interstices of a knitted Dacron graft 12 years after its implantation: Report of a case

Akiyama, K; Takazawa, Arifumi; Hirota, Jun; Yamanishi, Hiroshi; Akazawa, Toshimasa; Maeda, Takeshi

doi:10.1007/bf02482795

Cited by 5 publications

(5 citation statements)

References 8 publications

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“…Even though they are considered safe vascular substitutes, complications related to their fatigue have been occasionally reported, including dilation, bleeding, frank aneurysms, or rupture of the graft. [1][2][3][4] On the other hand, some recent reports suggest that the size of the modern generation of aortic Dacron grafts remains without significant dilation during follow-up, despite an initial increase in diameter noticed in the immediate postoperative period.57 These features could be related to discrepancies between the registered manufacturer's sizing and the diameters measured before and during implantation.…”

Section: Introductionmentioning

confidence: 99%

Knitted Dacron Grafts Used for Abdominal Aortic Reconstruction: Sizing References

Alonso-Pérez

Segura²,

Luján³

et al. 2001

Vascular Surgery

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This study was undertaken to analyze immediate and mid-term knitted Dacron graft dilation and to establish which parameters should be taken as a reference when aortic graft dilation is evaluated. A Dacron knitted microvel double velour vascular graft (Hemashield Gold) was implanted in 30 patients with aneurysmal (19 cases, 63%) or occlusive (11 cases, 37%) aortic disease. The stems of bifurcated prostheses (27 patients, 90%) and tube grafts (3 patients, 10%) were measured. The package sizing (labelled size) was compared with the external diameter measured intraoperatively with a slide caliper, prior to implantation and after complete clamp release. Additional measurements were obtained by ultrasound 1 and 6 months after implantation, and in 16 cases (53% of the patients) ultrasound and computed tomography (CT) were performed at the end of the first year. The means of the measurements were compared using Student's t test for matched pairs. The statistical significance level was set at p values < 0.05. There was a statistically significant difference between the package sizing (15.3 +/- 1.1 mm) and the external diameter measured prior to implantation (18.7 +/- 1.3 mm); and with the external diameter following implantation (19.6 +/- 1.4 mm), (p < 0.01). External diameters measured prior to grafting and following implantation (after complete clamp release), when compared with the manufacturer's size, showed a mean increase in graft diameter of 3.4 mm (22%) and 4.3 mm (28%), respectively. There were no statistical differences between the external diameter measured after clamp release (19.6 +/- 1.4 mm) and the size determined by ultrasound 4 weeks (19.3 +/- 1.2 mm) and 6 months (19.8 +/- 1.5 mm) following surgery (p values 0.11 and 0.56, respectively). Considering size after clamp release as a reference (19.6 +/- 1.4 mm), an almost significant (p = 0.08) increase in the diameter (0.7 +/- 1.5 mm) was obtained at the end of the first year when the measurement was performed with ultrasound. However, when the measurement was performed by CT at the end of the first year, the differences (0.9 +/- 1.6 mm) revealed statistical relevance (p = 0.04). There was no statistically significant difference between the sizes obtained by ultrasound (20.3 +/- 2.1 mm) and by CT (20.5 +/- 2.2 mm) at the end of the first year (p values 0.07). The package sizing is not a reliable parameter for choosing the size of knitted Dacron grafts. Immediate increase in diameter noted in Dacron grafts is caused by discrepancies between the package sizing and the measured diameter after clamp release during implantation, and by an initial adaptation of the textile structure. This must be taken into account for an accurate investigation of the immediate graft dilation rate, and if further follow-up is contemplated, a measurement to be taken as a reference should be performed by ultrasound or CT in the immediate postoperative period.

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Section: Introductionmentioning

confidence: 99%

Knitted Dacron Grafts Used for Abdominal Aortic Reconstruction: Sizing References

Alonso-Pérez

Segura²,

Luján³

et al. 2001

Vascular Surgery

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“…The causes of postoperative sac enlargement include PGS, infection, anastomotic aneurysms, transinterstitial bleeding through the graft, and minor bleeding from the sac. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 The last three resemble type I, IV, and II endoleaks, respectively, and a PGS resembles a type V endoleak or endotension in the endovascular aortic repair era. Sac enlargement can cause rupture and acute limb-threatening ischemia owing to graft thrombosis.…”

Section: Discussionmentioning

confidence: 99%

“…Sac dilation after open abdominal aortic aneurysm (AAA) repair has been reported and is mainly caused by perigraft seroma (PGS) or hygroma; additional causes include infection and bleeding. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 A PGS is a rare complication defined as a persistent, sometimes expanding, sterile fluid collection within a nonsecretory, fibrous pseudomembrane surrounding a patent vascular graft. 1 Herein, we describe a case of sac enlargement occurring 11 years after open AAA repair, which resulted from PGS and back-bleeding from the remnant wall.…”

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confidence: 99%

Sac enlargement due to perigraft seroma and back-bleeding from the remnant wall 11 years after open surgical repair of an infected abdominal aortic aneurysm

Hanada

Hoshina

Suhara

et al. 2022

Journal of Vascular Surgery Cases, Innovations and Techniques

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…In the early postoperative phase, it is hard to distinguish from postoperative fluid collections, such as hematoma, lymphocele, and infection. At the late postoperative phase, follow-up examinations such as CT scan and ultrasonography are usually selectively performed if a patient presents with any of symptoms or problems relation to the operation [12,13] In this case, CT was performed to ascertain the cause of symptoms reported by the patient who underwent surgical repair of AAA six years ago. It is also important to carefully screen patients with causative factors for PGS.…”

Section: Discussionmentioning

confidence: 99%

“…Although we can presume which causative factor is responsible for the development of PGS, there is no objective or effective tools for predicting failure of graft incorporation or insufficiency of graft fibrosis. It is possible that augmented graft permeability is related to excessive graft manipulation or pressurized irrigating solutions in the graft [9][10][11][12][13][14]. Therefore, this causative factor may be prevented by graft-controlled carefulness.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Relining Therapy of Peri Graft Seroma After Open Repair of Abdominal Aortic Aneurysm with Polytetrafluoroethylene Graft; Report of a long-term follow-up Case

Go¹,

Chun

Kim

et al. 2019

BJSTR

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Peri-graft seroma (PGS) is defined as a sterile, serous fluid collection confined around a prosthetic vascular graft and rarely reported to be in pathophysiologic unknown cause. Case Report:The authors experienced endovascular treatment of a peri-graft seroma that developed after open surgical repair of abdominal aortic aneurysm (AAA) with polytetrafluoroethylene (PTFE) graft. A 75-year-old man presented with growing aneurysm after open surgical repair of AAA with a PTFE bifurcated graft six years prior. The patient was referred to abdominal discomforts and physical exam revealed a palpable huge mass in the absence of tenderness, pulse, bruit and skin redness. Contrast enhanced computed tomography (CT) showed a huge peri-graft seroma measuring 112 mm in the longest diameter. The patient underwent endovascular PTFE graft relining with an Aortic extender, Excluder, and 10 mm x 10 cm stent-grafts, which named as Vaibhav. At 30 months follow-ups, CT revealed that a decreased seroma size from 112 mm to 59 mm in the longest diameter without flow disturbance. Conclusion:Endovascular relining of the PTFE bifurcated graft should be considered as a treatment option for PGS of AAA.

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Bleeding through the fiber interstices of a knitted Dacron graft 12 years after its implantation: Report of a case

Cited by 5 publications

References 8 publications

Knitted Dacron Grafts Used for Abdominal Aortic Reconstruction: Sizing References

Knitted Dacron Grafts Used for Abdominal Aortic Reconstruction: Sizing References

Sac enlargement due to perigraft seroma and back-bleeding from the remnant wall 11 years after open surgical repair of an infected abdominal aortic aneurysm

Endovascular Relining Therapy of Peri Graft Seroma After Open Repair of Abdominal Aortic Aneurysm with Polytetrafluoroethylene Graft; Report of a long-term follow-up Case

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