Perigraft seroma after total aortic arch replacement using Triplex graft

• DOI: 10.1007/s11748-022-01810-w
• Publication Date: 2022-03-29T10:14:57Z
• Authors: Yugo Kunibe; Masahiko Ando; Hyoe Komae; Shogo Shimada; Osamu Kinoshita; Haruo Yamauchi; Minoru Ono
• Keywords: Adult; Male; Vena Cava, Superior; Aortic Aneurysm, Thoracic; Aorta, Thoracic; Blood Vessel Prosthesis; 3. Good health; Blood Vessel Prosthesis Implantation; 03 medical and health sciences; Seroma; Treatment Outcome; 0302 clinical medicine; Humans; Polytetrafluoroethylene

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.