Southern Association For Vascular Surgery

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Perigraft-Peritoneal Shunt: Novel treatment of resistant Bypass perigraft seromas
Shadi J Abu-Halimah, Ali F AbuRahma
WVU-Charleston, Charleston, WV

INTRODUCTION: Perigraft seroma is a rare complication occurs after placement of any vascular graft. Several treatment options have been proposed. We are presenting this minimally invasive novel approach.
METHODS: 50 year old female patient with severe claudication in her lower extremities underwent right Axillary bifemoral bypass with 8 mm ringed Gortex graft from outside facility. Post operatively she presented with perigraft seroma extending from axillary area to the right groin that was causing significant discomfort and pain. Percutaneous drainage was attempted. Her nutrition was optimized and was given oral antibiotics for 4 weeks although cultures were negative. She had recurrence in 1 month. Open surgical drainage was performed with perigraft talc spray around the perigraft dead space. She redeveloped the seroma. We performed laparoscopic assisted placement of perigraft to peritoneal shunt. A 12mm infraumbalical port was placed intraperitoneal and a 5mm port at the right subcostal area in the anterior axillary line was placed through the perigraft cavity and then into the peritoneal cavity. 19fr fluted drain pushed under visualization through the subcostal port and was feed on top of the liver. The drain was cut into appropriate length and was pushed to coil in the perigraft area. RESULTS: Patient was discharged same day. She had no recurrence of seroma and on one year follow up CT scan shows patent graft with no recurrence.
CONCLUSIONS: Laparoscopic assisted shunt placement from perigraft seroma to peritoneal cavity is minimally invasive approach to treat this difficult rare problem with great result and preserving the bypass graft. Long term effect or infection risk is difficult to assess secondary to rarity of such complication.

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