Expanding perigraft seroma after ascending aorta replacement

Abstract

Background Perigraft seroma is a persistent and sterile fluid confined within a fibrous pseudomembrane surrounding a graft that develops after graft replacement. Development of perigraft seroma is an uncommon complication that occurs after the surgical repair of the thoracic aorta using woven polyester grafts. mechanism underlying perigraft seroma formation remains unclear. Case presentation Herein, we describe the case of 77-year-old man who underwent repeat sternotomy for the treatment of large perigraft seroma 1 year after ascending aorta replacement for acute type A dissection. After removing a cloudy yellow fluid, we covered the prosthetic graft with fibrin glue and wrapped it with a new graft. Bacterial culture and laboratory examination of the fluid confirmed the final diagnosis of perigraft seroma, and there was no evidence of recurrence. The area in which fluid accumulated around the graft shrunk 1 year after surgery. Conclusions The cause of a expanding perigraft after repair of the thoracic aorta remains unknown. Physicians should be aware that chronic expanding mediastinal seroma with Dacron grafts is one of the rare postoperative complications of thoracic aortic surgery. Applying fibrin glue to the graft surface might effectively prevent the recurrence of perigraft seroma.

Mediastinal perigraft seroma after thoracic aortic surgery

“…The asymptomatic nature and deep anatomical location of PGS preclude easy detection by physical examination, which may be the reason for their low incidence. Seromas are relatively common in superficially placed grafts (such as axillofemoral and femorofemoral bypasses), whereas deep graft seromas occur much less frequently, and seromas have been described mainly in abdominal aorta grafts [ 4 , 6 ]. In general, PGS after abdominal aortic aneurysm repair often causes some symptoms due to the formation of space-occupying lesions; however, mediastinal PGS after thoracic aortic aneurysm repair is not always accompanied by symptoms due to the larger free space in the mediastinum.…”

“…In general, the diagnosis of PGS is made by excluding other differential diagnoses such as haematoma, infection and lymphorrhea [ 6 ]. Kadakol et al defined PGS as perigraft fluid collection that presents at >3 months after surgery, with a diameter of >3.0 cm and radiodensity on CT scans <25 HU.…”

“…Bleeding due to anastomotic dehiscence without infection is rare but needs to be excluded as well. Infection and haematoma are frequently occurred in the early postoperative phase [ 6 ]. In about 50% of cases, the cause of low-density perigraft fluid accumulation has not been identified [ 7 ], and patients remain asymptomatic.…”

“…The treatment option of replacing the original graft with a new one made of different material has been reported to be effective [ 10 , 25 ]. Recent advancements in surgical intervention include fibrin glue applied to the graft [ 6 ], wrapping the graft using omentum [ 26 ] and endovascular relining of the prosthesis [ 27–29 ].…”