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Novel and Innovative Hybrid Technique for Type A Aortic Dissection

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Perigraft seroma after total aortic arch replacement using Triplex graft.

Yugo Kunibe¹, Masahiko Ando², Hyoe Komae¹

¹Department of Cardiovascular Surgery, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo, Tokyo, 113-8655, Japan.

General Thoracic and Cardiovascular Surgery

|March 29, 2022

Summary

Perigraft seroma (PGS) is a rare complication following aortic arch replacement. This case highlights diagnostic challenges and management strategies for PGS, emphasizing its uncommon occurrence with Triplex grafts.

Keywords:

Aortic arch Aortic surgery Perigraft seroma Vascular graft prosthesis

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Area of Science:

Cardiovascular Surgery
Thoracic Surgery
Vascular Surgery

Background:

Acute type A aortic dissection requires surgical intervention, often involving aortic arch replacement with synthetic grafts.
The Triplex graft is a type of synthetic material used in aortic arch reconstruction.

Observation:

A 42-year-old male developed a rapidly enlarging, low-density, non-enhancing area around a Triplex graft 16 months post-aortic arch replacement.
This perigraft collection compressed vital mediastinal structures, including the superior vena cava and right pulmonary artery.

Findings:

Diagnostic workup for suspected lymphorrhea or perigraft seroma (PGS) included fluid analysis, chyle leak testing, and intraoperative lymphangiography, all yielding negative results for lymphatic or chyle leakage.
Despite negative findings for specific etiologies, the clinical presentation and imaging were most consistent with PGS.

Implications:

Perigraft seroma is an exceptionally rare complication after aortic arch replacement, particularly when using a Triplex graft.
This case underscores the importance of considering PGS in the differential diagnosis of mediastinal fluid collections post-aortic surgery and discusses diagnostic and therapeutic approaches.