Lymphatic complications after vascular interventions.

Abstract

IntroductionLymphorrhea due to classical and mini-invasive surgical interventions on femoral and popliteal arteries is a serious hindrance to patient treatment. Depending on the experience of a particular center, the incidence and frequency of this type of complication may constitute a serious clinical problem. While the level of lymphorrhea intensity and its duration result in certain foreseeable consequences, their treatment can be a time-consuming and multistep procedure.AimTo compare different types of vascular interventions with lymphorrhea occurrence.Material and methodsThe authors conducted a retrospective analysis of lymphatic complications based on the material collected between 2005 and 2012 at the Department of Vascular and Endovascular Surgery of the Military Institute of Medicine in Warsaw and in the Department of Interventional Cardiology and Angiology of the Institute of Cardiology in Anin, Warsaw, in 2009–2012.ResultsMaintaining due thoroughness when dissecting tissues and treating the cutting line in this area with ligatures and tissue puncture are the most reliable methods of minimizing the risk of lymphatic leakage after surgical procedures performed in a classical way. The lymphatic complication under analysis is far less likely to occur when procedures are performed as planned and an endovascular technique is used – statistical significance p < 0.05. Minimally invasive and fully percutaneous procedures performed via needle puncture, including the use of the fascial closure technique to close the femoral artery, eliminate the likelihood of the occurrence of this vascular complication – statistical significance was found with p value less than 0.05.ConclusionsWe concluded that in every case by minimizing the vascular approach we protected the patient against lymphatic complications.

Predilation technique with balloon angioplasty to facilitate percutaneous groin access of large size sheath through scar tissue

“…In addition, redo surgery has been identified as a significant risk factor for surgical site and vascular graft infection, 13 bleeding from infected regions and septicemia. 14 To reduce the risk of such complications, a percutaneous approach was employed in all patients of this series.…”

Wound complications after common femoral vein endophlebectomy: Influence on outcome

“…23 In general, surgical procedures requiring groin incisions are associated with a higher rate of wound complications. 24 The presented study was able to identify factors, which may be associated with an increased risk for deteriorated wound healing. Former intravenous drug abuse and previous venous interventions as well as surgical procedures like thrombectomy showed an increased, but not significant association with wound complications.…”

“…23 In general, surgical procedures requiring groin incisions are associated with a higher rate of wound complications. 24…”

Algorithmic approach to the lymphatic leak after vascular reconstruction: a systematic review

“…Lymphatic leak is a serious complication of vascular surgery that incurs significant cost to the healthcare system and morbidity to the patient [1][2][3][4][5]. Disruption of lymphatic channels during vascular surgery and failure of subsequent healing may result in persistent leakage, presenting as lymphocele or lymphocutaneous fistula, and may occur in as many as 18% of arterial interventions [6]. A variety of factors have also been identified that may predispose patients to lymphatic leak including surgical procedure and graft type, incision techniques, as well as patient demographics [3,5,7].…”

“…A variety of factors have also been identified that may predispose patients to lymphatic leak including surgical procedure and graft type, incision techniques, as well as patient demographics [ 3 , 5 , 7 ]. As a result, patients who develop postvascular dissection lymphatic leak have delayed wound healing, are at greater risk of infection and graft rejection, and spend more time in the hospital, thereby increasing the cost of care [ 2 , 5 , 6 ].…”