A Case of Perigraft Seroma after Ascending Aorta Replacement That Was Cured by an Omental Pedicle Graft

Go, Seimei; Takahashi, Shinya; Morita, Shohei; Maeda, Kazuki; Katayama, Kosuke; Kurosaki, T.; Sueda, Taijiro

doi:10.4326/jjcvs.47.248

Cited by 3 publications

(3 citation statements)

References 8 publications

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“…Spartera et al reported postoperative perigraft fluid collection areas greater than 3.5 cm in diameter at 1 month after the operation in 19% of cases of aortic reconstruction, with postoperative perigraft fluid collection often noted [1]. However, a subcutaneous tumor due to development of a perigraft seroma after thoracic aortic surgery is an infrequently encountered complication, with only three cases reported thus far in literature [2][3][4]. In order to effectively treat this subcutaneous tumor, confirmation of diagnosis is important, and when it appears secondary to an anastomotic rupture, pseudoaneurysm, or graft infection, treatment must be performed as soon as possible.…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis is made based on physical examination, blood test, bacterial culture of the tumor, CT, and radiodensity results, as well as other indications. However, Go et al reported a case with a perigraft seroma that appeared after a Bentall operation, in which artifacts seen in enhanced CT images were considered to be extravasation of contrast media and an anastomotic rupture was mistakenly diagnosed, resulting in a redo sternotomy [3].…”

Section: Discussionmentioning

confidence: 99%

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Subcutaneous extension of perigraft seroma after thoracic aortic surgery — report of three cases

Doita

Yamasumi

Nakamura

et al. 2023

Gen Thorac Cardiovasc Surg Cases

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Background Subcutaneous extension of a perigraft seroma following thoracic aortic surgery is an infrequently encountered complication. For treatment, it is necessary to first exclude the possibility of perigraft fluid collection secondary to infection, a pseudoaneurysm, or impending rupture. However, it is difficult to diagnose collected fluid as indicative of a perigraft seroma, and there is also no standardized treatment for this condition. Case presentation Three patients who had undergone graft replacement of a thoracic aorta with arch reconstruction were referred to our department for findings of a subcutaneous tumor. In each, computed tomography showed perigraft fluid accumulation in the posterior sternum. In one, a subcutaneous tumor had appeared in the center area of the median sternotomy, 4 months after the operation. It was considered that a wound infection was the likely cause; thus, negative pressure wound therapy was started after incisional drainage and debridement. However, a fever developed 14 days after debridement, resulting in mediastinitis, the latter of which was assumed to be caused by a retrograde infection of the incisional wound. In the other two cases, a subcutaneous tumor appeared in the center of the median area of the sternotomy at 3 and 4 months, respectively, after the operation. In both, the tumor was treated with continuous drainage by aspiration with negative pressure, and cultures of drainage samples were negative for infection. Neither patient had a fever during hospitalization, and fluid collection disappeared during follow-up. In one of the latter two cases, a subcutaneous tumor formed again 3 months after drainage, which was treated in the same manner and subsequently disappeared. Thereafter, there was no recurrence noted at the 3-year follow-up examination. Conclusion A perigraft seroma following thoracic aortic surgery, an infrequently encountered complication, has an appearance is similar to a subdermal tumor. Continuous aspiration drainage is a useful option for patients with no fever and negative for infection in drainage culture results.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Subcutaneous extension of perigraft seroma after thoracic aortic surgery — report of three cases

Doita

Yamasumi

Nakamura

et al. 2023

Gen Thorac Cardiovasc Surg Cases

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“…The treatment option of replacing the original graft with a new one made of different material has been reported to be effective [ 10 , 25 ]. Recent advancements in surgical intervention include fibrin glue applied to the graft [ 6 ], wrapping the graft using omentum [ 26 ] and endovascular relining of the prosthesis [ 27–29 ].…”

Section: Discussionmentioning

confidence: 99%

Mediastinal perigraft seroma after thoracic aortic surgery

Suzuki,

Akita,

Miyazaki

et al. 2023

Interdisciplinary CardioVascular and Thoracic Surgery

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OBJECTIVES We investigated pertinent factors associated with mediastinal perigraft seroma (PGS) after thoracic aortic surgery. In addition, we provided a clinical review of this entity, as reports reviewing abundant mediastinal PGS cases are rare. METHODS Eighty-two patients who underwent either ascending aortic replacement or aortic arch replacement between 2016 and 2022 in our institution were enrolled in the present study. Postoperative computed tomography scans were performed to detect fluid capsules with a diameter ≥3.0 cm and radiodensity ≤25 Hounsfield units. Patients who did and who did not develop PGS formation were compared. Variables with a statistically significant difference between these groups were included in a multiple logistic regression analysis along with other factors associated with PGS in the literature. RESULTS The incidence rate of PGS was 14.6% (12/82). The average radiodensity of the mass was 16.6 ± 6.3 Hounsfield units. The average onset of PGS was 8.5 months post-surgery. Multivariate logistic regression analysis revealed that ejection fraction [odds ratio (OR): 1.25, 95% confidence interval (CI): 1.03–1.50, P = 0.021], aortic dissection (versus degenerative aortic aneurysm) (OR: 6.61, 95% CI: 1.35–32.4, P = 0.02) and warfarin use (OR: 6.67, 95% CI: 1.19–37.1, P = 0.03) significantly contributed to mediastinal PGS after thoracic aortic surgery. CONCLUSIONS High ejection fraction, warfarin use and aortic dissection (versus degenerative aortic aneurysm) contributed significantly to mediastinal PGS formation after thoracic aortic surgery. Careful serial postoperative imaging studies and fluid analysis can be used to guide treatment plans. Clinical trial registration UMIN-CTR (University hospital Medical Information Network-Clinical Trial Registry) Registration number: UMIN000050764.

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Surgical Treatment for Aseptic Mediastinitis in the Late Phase after Aortic Root and Arch Replacement

et al. 2023

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Objective: A few cases of an aseptic abscess after thoracic aortic surgery have been reported. However, it sometimes requires surgical treatment because the rapid growth of perigraft fluid collection results in exposure towards the body surface. We discuss the results of our treatment of these cases. Methods: This study was a retrospective analysis. Four of 341 cases who underwent thoracic aortic surgery between April 2013 and March 2020 were included. These cases presented with a bulge of the body surface 10.3 (range, 3-27) months after surgery. Results: Although the fluids looked purulent in all cases, no bacteria were detected. We diagnosed them as aseptic abscess, for which omental implantation was performed. No signs of recurrence have been found in any cases even after 5.4 (range, 1-8.5) years. Conclusions: Omental implantation was effective for controlling aseptic abscess for long-term periods.

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A Case of Perigraft Seroma after Ascending Aorta Replacement That Was Cured by an Omental Pedicle Graft

Cited by 3 publications

References 8 publications

Subcutaneous extension of perigraft seroma after thoracic aortic surgery — report of three cases

Subcutaneous extension of perigraft seroma after thoracic aortic surgery — report of three cases

Mediastinal perigraft seroma after thoracic aortic surgery

Surgical Treatment for Aseptic Mediastinitis in the Late Phase after Aortic Root and Arch Replacement

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