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Aseptic periprosthetic fluid collection: a late complication of Dacron arterial bypass
F Bellenot1, T Chatenet, B Kantelip
1Service de Chirurgie Vasculaire, Centre Hospitalo-Universitaire de Clermont-Ferrand, France.
Abstract:
Fluid collection encompassing an arterial prosthesis often leads one to suspect graft infection. Four cases of aseptic seroma occurring three to five years after insertion of knitted Dacron implants for bypass are reported. The collection was serohematic in three cases, puriform in the other. Repeated bacteriological investigations did not reveal any growth and laboratory tests did not demonstrate any signs of infection. The following pathophysiologic hypotheses have been advanced: modification of the permeability of the prosthetic wall, immunoallergic reaction to the graft, and aging hematoma. The role played by anticoagulant is debatable. Management by needle aspiration or drainage failed. Multiple recurrences led to prosthetic replacement in three cases. Treatment consists of replacing the graft by one of a different fabric. These collections must be distinguished from postoperative lymphoceles, anastomotic false aneurysms, hematomas and infections.
Insights
Aseptic seroma, a fluid collection around arterial grafts, can mimic infection years after surgery. Management is challenging, often requiring graft replacement.
Area of Science:
- Vascular Surgery
- Biomaterials Science
Background:
- Fluid collections near arterial prostheses often suggest graft infection.
- Knitted Dacron implants are commonly used for bypass procedures.
Observation:
- Four cases of aseptic seroma developed 3-5 years post-implantation of Dacron grafts.
- Collections were serohematic or puriform, with negative cultures and no infection markers.
- Needle aspiration or drainage proved ineffective, with frequent recurrences.
Findings:
- Aseptic seroma is a distinct complication of arterial prostheses, presenting years after implantation.
- Potential causes include altered graft permeability, immunoallergic reactions, or resolving hematomas.
- Anticoagulant use's role remains uncertain.
Implications:
- Differentiating aseptic seroma from graft infection is crucial for appropriate management.
- Treatment often necessitates prosthetic replacement with a different material.
- This condition requires distinction from lymphoceles, aneurysms, hematomas, and true infections.