Perigraft seromas complicating prosthetic bridge arteriovenous fistula--solution with autogenous vein interposition.

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Introduction greater saphenous vein, placed along the same route. The seroma did not recur and the fistula remained A perigraft seroma is a collection of clear and sterile patent on the last follow up at 4 months. ultrafiltered serum, encased by a fibrous pseudocapsule, that develops around a patent prosthetic vasCase 2 cular graft. Several treatments have been suggested but none have proved to be consistently satisfactory. A 50-year-old man, under haemodyalisis for 20 years, We describe four cases of perigraft seroma comhad his long-standing left brachioaxillary 6-mm diaplicating brachioaxillary arteriovenous polytetrameter PTFE arteriovenous bridge fistula abandoned fluoroethylene bridge fistula. Extensive dissection, because it thrombosed repeatedly. A new left braheparin and corticoid therapies were predisposing chioaxillary PTFE arteriovenous bridge fistula was factors. All cases were managed successfully by reconstructed along a new subcutaneous route. The placing the transuding segment of prosthesis with arterial anastomosis was constructed to a 1 cm-long autogenous vein and excision of the pseudo-capsule. segment of the old, well-incorporated prosthesis, anaThis procedure resulted in resolution of the seroma stomosed to the brachial artery. The venous anawith preservation of the arteriovenous graft, leaving stomosis was constructed to the more proximal axillary the shunt immediately available for cannulation of the vein. A perigraft seroma ensued around the arterial unreplaced segment. anastomosis. Twelve weeks later the seroma and its pseudocapsule were resected. During surgery, it was observed that the old retained segment of prosthesis Case 1 was encased in fibrous tissue while the new prosthesis was transuding. The 4-cm long, transuding proximal A 59-year-old man with end-stage renal failure undersegment of prosthesis at the arterial anastomosis was went a left brachioaxillary arteriovenous 6-mm diareplaced with reversed greater saphenous vein, which meter polytetrafluoroethylene (PTFE) bridge fistula was interposed between the old, well-incorporated 1because of a lack of suitable veins. A perigraft seroma cm long segment and the remaining new PTFE prosdeveloped around the arterial anastomosis. Three thesis. The seroma did not recur and the vascular weeks later aspiration was attempted without success. access remained patent on last follow up at 4 months. The culture of the fluid was negative. Two weeks afterwards the pseudocapsule was resected. The 4-cm long, transuding proximal segment of prosthesis at Case 3 the arterial anastomosis was replaced with reversed