Perigraft seroma: clinical, histologic, and serologic correlates

Area of Science:

• Vascular Surgery
• Surgical Pathology
• Immunology

Background:

• Perigraft seroma is a sterile fluid collection at prosthetic graft sites.
• It is associated with complications like graft thrombosis, infection, and limb loss.

Purpose of the Study:

• To investigate the incidence and outcomes of perigraft seroma.
• To explore the pathogenesis of perigraft seroma, focusing on fibroblast inhibition.

Main Methods:

• Retrospective analysis of 118 extraanatomical bypasses, 248 aortic reconstructions, and 395 femoropopliteal bypasses over 14 years.
• Histologic examination of seroma walls and fibroblast cultures.
• In vitro testing of patient sera for fibroblast inhibition using pseudomembrane-derived fibroblasts.

Main Results:

• Nine cases of perigraft seroma were identified (0.3-4.2% incidence).
• Associated complications included graft thrombosis (5 cases), limb loss (1 case), graft infections (2 cases), and deaths (2 cases).
• Sera from perigraft seroma patients inhibited fibroblast growth, unlike sera from healthy subjects or patients with well-incorporated grafts.

Conclusions:

• Perigraft seroma is associated with significant morbidity, including graft and limb loss, and necessitates reoperations.
• The pathogenesis likely involves a humoral fibroblast inhibitor that impairs graft incorporation.
• The graft may induce host production of this inhibitor, suggesting therapies targeting fibroblast modulation or graft removal.