Fibrin sealant injection through the drain with adjuvant compression as a treatment of groin lymphatic complications after vascular operation

Abstract

Introduction: Groin lymphatic complications after femoral artery operations are rare, but if developed, they could be a source of severe complications that could be potentially fatal. The novel technique of combining compression and application of Tisseel sealant (Baxter AG, Vienna, Austria) to treat lymphatic fistulas in the groin region after common femoral artery exposure was evaluated. Material and methods: Twelve groins from eleven patients with groin lymphatic complications were enrolled into the study. Patients had femoral artery exposure during one of the following procedures: endovascular aortic aneurysm repair, thrombendarterectomy or extra-anatomic by-pass. Postoperatively, average lymphatic drainage through the drain was 140 ± 60 (range 48–300) mL per day. Intervention was performed at a median of 12 (9–23) days after operation. The drain was cut off close to the skin, a thin double-channel catheter was introduced as deep as possible through the drain and sealant was injected into the wound. Simultaneously, the remaining part of the drain was removed, the orifice in the skin was sutured and a compression dressing was kept in place for 24 hours. The median patient observation period was 13 months (range 2.5–23) and surveillance of the groin was performed using ultrasonography. Results: Early outcomes showed full technical success. None of the patients were readmitted due to lymphorrhea, infection or poor wound healing during follow-up. No lymphoceles were detected by ultrasonography. Conclusion: Fibrin glue injection augmented by compression is an effective method for treating postoperative lymphatic fistulas and to prevent lymphorrhagia and lymphocele formation in the groin region after femoral artery exposure.