新規血管アクセスグラフト周囲嚢腫に対する閉塞再開通法：多施設共同症例報告

Arteriovenous grafts remain crucial for hemodialysis access despite the risk of perigraft seromas (PSs)-sterile fluid collections causing graft compression, thrombosis, and dysfunction. Current treatments (surgical drainage and compression therapy) show high recurrence rates. We describe a novel occlusion-reopening technique for refractory PSs in 5 patients receiving hemodialysis (mean age, 62.6 years) with expanded polytetrafluoroethylene AVGs. All seromas developed at arterial anastomoses (1-43 days after placement) and recurred after conventional therapies. Our protocol involved (1) intentional graft occlusion via manual compression to induce thrombosis, (2) complete surgical seroma evacuation with pseudocapsule preservation, and (3) percutaneous transluminal angioplasty using 6-mm balloons for graft reopening (see Fig 1 for details). Technical success was achieved in all cases, with immediate restoration of thrill/bruit and mean post-percutaneous transluminal angioplasty flow of 1320 mL/min. No seroma recurrences occurred during follow-up, and all AVGs remained functional. The occlusion-reopening technique addresses PS pathophysiology by eliminating fluid production through temporary thrombosis while preserving graft architecture. This approach demonstrates 100% efficacy in our series for recurrent PSs unresponsive to standard therapies, offering a reproducible solution with durable outcomes.