Endoluminal Stent-Graft Relining of Visceral Artery Bypass Grafts to Treat Perigraft Seroma

Abstract

PURPOSE: To describe the endovascular treatment of intra-abdominal perigraft seromas associated with small-caliber expanded polytetrafluoroethylene (ePTFE) grafts. CASE REPORTS: Two patients who underwent hybrid repair of thoracoabdominal aortic aneurysms in which renovisceral bypass grafts were implanted presented with large, symptomatic perigraft seromas. The 5-to 8-mm-diameter ePTFE bypass grafts believed to be involved in the seromas were successfully relined with self-expanding Viabahn stent-grafts in percutaneous procedures. The patients' symptoms were relieved, and imaging follow-up (18 and 10 months, respectively) has shown near complete resorption of the seromas. CON-CLUSION: It is expected that this minimally invasive technique could be very valuable in treating aortic, renovisceral, and peripheral perigraft seroma.

Endovascular treatment of perigraft seroma in patient with prior hybrid thoracoabdominal repair using visceral bypass to relieve duodenal obstruction

“…However, those require a relaparotomy, an invasive procedure. On the other hand, endovascular repair methods that do not require a relaparotomy and minimally invasive for covering pores inside the graft have been recently developed, with seven cases that used AneuRx ® (Medtronic, Minneapolis, Minn), and Excluder ® and Viabahn ® (W. L. Gore & Associates, Flagstaff, Ariz) devices reported [2,[6][7][8][9] (Table 1). In those cases, a relaparotomy was considered difficult because of elderly age or history of multiple laparotomies.…”

“…In the present case, PS was localized around the right RA ePTFE graft, thus that was suspected to be the causative factor, because of the site and graft material, and stent relining for that alone was considered to be achievable. It was also noted that Lachat, et al reported two cases of endovascular repair for PS after visceral bypass surgery, where stent relining was performed for only the affected graft because of PS localization and graft material [7]. In cases of PS after visceral bypass surgery, the affected graft can be determined based on PS localization and graft material composition, allowing for a minimally invasive intervention method.…”

Perigraft seroma penetrating the aortic sac and rupturing into the intraperitoneal cavity

“…Alternative methods for graft preservation in patients with perigraft seroma after open abdominal aneurysm repair include omental transfer 21 around the graft and endovascular relining of the prosthesis,14, 15, 22, 23 but neither approach seems to be as effective as removal and replacement of the original graft.…”