Perigraft Seroma after Extra-anatomic Bypass: Case Series and Review of the Literature

Abstract

Extra-anatomic bypass (EAB) remains a viable alternative for lower limb revascularization if aorto-bifemoral bypass and endovascular therapy are contraindicated. Among EAB, perigraft seroma (PS) occurs in about 4% of cases. Diagnostic and therapeutic management, as well as standardized treatment paradigm, are still not well defined. The aim of this study is to report 5 PS cases in EAB and to review the literature about similar cases. We retrospectively reviewed EAB performed during the period 2002-2015. Among these, PS cases were analyzed. A similar description for all cases found in the literature through research on the major international databases (PubMed, Scopus, EMBASE) was conducted. During the study period, 797 bypasses-528 (66.3%) anatomical and 269 (33.7%) extra-anatomical-were performed. Among the latter, 169 femoro-femoral (FF), 20 axillo-femoral (AXF), 22 axillo-bifemoral (AxBF), and 58 aortouni-iliac endoprosthesis (AUI)+FF bypasses were performed. Five cases (1.86%) of PS in EAB population were detected: 3 after AxBF and 2 after AUI+FF. Although we initially preferred percutaneous drainage, a surgical choice with graft explant and replacement were imposed by the high recurrence rate. Literature analysis identified 20 additional cases (11 after AxBF, 7 after AXF and one after AUI+FF). Our case series and the literature confirm that the most widely used therapy is the surgical drainage with primary or secondary replacement of the graft of a different material. Percutaneous drainage has proved to be ineffective because not conclusive and potential to increase risk of graft infection. Careful follow-up, even years after surgery, remains necessary for PS diagnosis and management, to prevent complications and potential infection.