Lymphocele following saphenous vein harvesting

Abstract

Case Study 58 yrs old female with coronary artery bypass graft (CABG) 10-months ago presented with a soft ball size lump on her left leg at the incision point where her saphenous vein was stripped off. The lump had gradually increased in size over months. Patient denied any local trauma, pain, or discharge. An examination revealed a 12 x 8 x 5 cm size, soft, mobile, non-pulsatile swelling medial and just above the knee without any associated erythema or tenderness (see figure ). An ultrasound with duplex doppler showed a non-vascular homogenous anechoic cystic fluid collection. Patient refused the needle aspiration or surgery due to fear of recurrence, but the findings were consistent with a diagnosis of lymphocele. So far, patient has had no symptoms except for the inconvenience of having a big lump on her thigh. Discussion: Lymphocele post- CABG is a subcutaneous collection of lymph fluid that develops due to disruption of lymphatic vessels during s aphenous vein harvesting. Although uncommon (1), it is associated with risk factors like female gender, obesity, diabetes mellitus and open saphenous vein harvesting (2,3). Treatment of these lymphoceles should initially be conservative, but if this approach fails, surgical excision should be performed and special attention paid to identifying and ligating the feeding lymphatic vessel (4).