Management of large post-crossover inguinal lymphocele

Abstract

A 73-year-old man with a history of peripheral arterial disease and previous bilateral common femoral artery reconstruction presented with left foot critical limb-threatening ischaemia and underwent right to left femoro-profunda crossover grafting. Postoperatively, he developed a left groin lymph leak that initially dried up but later re-presented as a very large lymphocele. Initial attempts with aspiration on three occasions and then surgical drainage with sac excision and ligation of long saphenous lymphatics did not lead to resolution. Subsequently, a hybrid approach using percutaneous lymphangiography and drainage, sclerotherapy (bleomycin, then absolute alcohol) and eventual identification and ligation of the afferent lymphatic channel resulted in resolution of the lymphocele without untoward side effects, sepsis or compromise of the revascularisation.