Perigraft seroma after total aortic arch replacement using Triplex graft

A 42-year-old gentleman underwent total aortic arch replacement with Triplex graft (Terumo corporation, Tokyo, Japan) for acute type A dissection. Sixteen months later, a computed tomography revealed a rapidly enlarging low-density area around the graft, with no contrast enhancement. The area was co...

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Bibliographic Details
Published in:	General thoracic and cardiovascular surgery Vol. 70; no. 7; pp. 668 - 672
Main Authors:	Kunibe, Yugo, Ando, Masahiko, Komae, Hyoe, Shimada, Shogo, Kinoshita, Osamu, Yamauchi, Haruo, Ono, Minoru
Format:	Journal Article
Language:	English
Published:	Singapore Springer Nature Singapore 01-07-2022 Springer Nature B.V
Subjects:	Aneurysms Antibiotics Anticoagulants Asymptomatic Biodegradable materials Cardiac Surgery Cardiology Case Report Conflicts of interest Connective tissue Diabetes Fibroblasts Hematoma Hemorrhage Infections Leukocytes Medical diagnosis Medical imaging Medicine Medicine & Public Health Pulmonary arteries Surgery Surgical Oncology Thoracic Surgery Tomography Veins & arteries Japan Perigraft seroma Aortic surgery Vascular graft prosthesis Aortic arch
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Summary:	A 42-year-old gentleman underwent total aortic arch replacement with Triplex graft (Terumo corporation, Tokyo, Japan) for acute type A dissection. Sixteen months later, a computed tomography revealed a rapidly enlarging low-density area around the graft, with no contrast enhancement. The area was compressing the mediastinal structures, such as the superior vena cava and right pulmonary artery. Suspecting lymphorrhea or perigraft seroma (PGS), surgical drainage was performed. Although fluid accumulation around the graft was cloudy and yellowish, Gram stain was negative. A fatty preparation was administered from the nasogastric tube, demonstrating no leakage of chyle. Intraoperative lymphangiography with indocyanine green also showed no lymphatic leak. Therefore, PGS was suspected. Fibrin glue was applied to the graft and the surgery was completed. PGS drainage after arch replacement, especially with Triplex graft, is extremely rare. We discuss the strategies of diagnosis and treatment for this uncommon complication after aortic surgery.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	1863-6705 1863-6713
DOI:	10.1007/s11748-022-01810-w