Perigraft reaction: Incompatibility of synthetic vascular grafts? new aspects on clinical manifestation, pathogenesis, and therapy

Abstract

Perigraft reaction can be defined as an aseptic biological incompatibility of synthetic vascular prostheses. The clinical picture is characterized by an indolent fluctuating swelling around the prosthesis, consisting of sterile fluid surrounded by a fibrous capsule. Since 1979, a total Of 22 perigraft reactions in 2,554 implanted vascular grafts were observed and analyzed. The incidence of this complication is about 8/1,000 both for Dacron | double-velour and expanded polytetrafluoroethylene (PTFE). Including 306 reports from the literature, prostheses in the extraanatomical position comprise nearly 75% of the material analyzed. The time interval between graft implantation and clinical manifestation is, on average, 25 months. Although the etiology is still unclear, the pathogenesis is supposed to be multifactoriah (a) there is mechanical trauma due to continuous shifting of the prosthesis in the surrounding tissue (especially in the case of extraanatomic grafts), (b) there is physicochemical irritation of the tissue bed by the graft material (velour surface, organic solvents), and (c) poor incorporation of the graft may lead to periprosthetic gap formation and fluid accumulation around the prosthesis. Infections, or immunologic or allergic causes can be excluded. Therapy includes total or partial replacement of the affected portion of the graft and cyst wall with substitution by a prosthesis of a different synthetic material. Repeated aspiration of the periprosthetic cyst should be avoided because of the high failure rate and danger of secondary infection.

Giant Perigraft Seroma after Axillobifemoral Bypass for Leriche’s Syndrome: A Case Report

“…1) It can occur with any type of prosthesis, although it occurs more with Dacron and ePTFE grafts, positioned with extra-anatomic course and in the lower limbs. 2,3) Pathogenetic factors, real incidence and therapeutic choices are not yet clarified. The appearance may also occur after years from surgery.…”

“…The incidence has been estimated 4% in extra-anatomic bypass 3) and 0.7%-0.8% in anatomic bypass of the lower limbs. 2,3) Etiology remains controversial. Although the hypothesis of a changing in underwent extra-anatomic bypasses, a regular follow-up to highlight the new appearance of possible periprosthetic collections.…”

Perigraft Seroma after Extra-anatomic Bypass: Case Series and Review of the Literature

“…Several hypotheses have been advanced to explain the serum accumulation after vascular graft implants, including both graft-or patient-related factors, although the pathogenesis appears to be multifactorial. The most likely theories include host versus graft reaction, 9 pseudoinfection, 21 immunoallergic reaction, 6,22 ultrafiltration, 8,10 anomalous graft incorporation, 23e26 failure of wound repair process, 26 fibroblast transformation 7 with fluid exudation by neobursa, and intraoperative lymphatic damage. 27 441 442 443 444 445 446 44...…”

Periprosthetic seroma occurrence after femoropopliteal bypass grafting: Surgical management after failure of non-surgical measures in relieving symptoms

“…The incidence of periprosthetic seroma (PS) has been estimated as 0.7–0.8% in vascular bypass procedures involving the lower extremity. 1 , 2 PS formation around prosthetic grafts is a well known complication after various revascularization procedures such as axillofemoral bypass, aortoiliac bypass, and femoropopliteal bypass (FPB). 3 PS has been defined as the collection of non-infected serous fluid around a prosthetic arterial graft.…”

“…4 PS has been reported to occur in various types of prosthetic graft implants such as Dacron and expanded polytetrafluoroethylene. 1 , 2 There have been reports in the literature of how to manage PS occurring after aortic revascularization procedures. 5 , 6 However, there is a dearth of literature on how to manage PS occurrence after FPB especially in patients whose symptoms do not improve with typical conservative measures such as elevation, compression stockings, or diuretics.…”