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Endarterectomy of the Aneurysm Sac in Open Abdominal Aortic Aneurysm Repair Reduces Perigraft Seroma and Improves Graft Incorporation

Wolff, Thomas ; Koller, Michael ; Eugster, Thomas ; Rouden, Christophe ; Marti, Regula ; Gürke, Lorenz ; Stierli, Peter

In: World Journal of Surgery, 2011, vol. 35, no. 4, p. 905-910

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    Titel
    • Endarterectomy of the Aneurysm Sac in Open Abdominal Aortic Aneurysm Repair Reduces Perigraft Seroma and Improves Graft Incorporation
    Autor
    • Wolff, Thomas. Department of Vascular Surgery, Basel University Hospital, Spitalstrasse 21, 4031, Basel, Switzerland
    • Koller, Michael. Institute for Clinical Epidemiology, Basel University Hospital, Hebelstrasse 10, 3rd Floor, CH-4031, Basel, Switzerland
    • Eugster, Thomas. Department of Vascular Surgery, Basel University Hospital, Spitalstrasse 21, 4031, Basel, Switzerland
    • Rouden, Christophe. Department of Vascular Surgery, Basel University Hospital, Spitalstrasse 21, 4031, Basel, Switzerland
    • Marti, Regula. Department of Vascular Surgery, Kantonsspital, Buchserstrasse, CH-5001, Aarau, Switzerland
    • Gürke, Lorenz. Department of Vascular Surgery, Basel University Hospital, Spitalstrasse 21, 4031, Basel, Switzerland
    • Stierli, Peter. Department of Vascular Surgery, Kantonsspital, Buchserstrasse, CH-5001, Aarau, Switzerland
    Dokumententyp
    • Postprint
    Sprache
    • Englisch
    Veröffentlicht in
    • World Journal of Surgery, 2011, vol. 35, no. 4, p. 905-910. Springer-Verlag
    Andere elektronische Ausgabe
    Klassifikation
    • Gesundheit
    OAI-PMH-ID
    • oai:doc.rero.ch:319483
    Summary
    Background: Fluid around the graft in the original aneurysm sac after open abdominal aortic aneurysm (AAA) repair is a poorly researched phenomenon. If large, such perigraft seroma can cause symptoms of compression, and cases of rupture have even been described. We assessed whether endarterectomy of the aneurysm sac reduces the incidence of perigraft fluid and improves graft incorporation. Design and methods: Starting in July 2005, all patients with elective open AAA repair were alternately treated either with conventional thrombectomy or thrombectomy plus endarterectomy of the aneurysm sac. All patients were treated with a polytetrafluoroethylene (PTFE) graft. The maximum axial width of the perigraft fluid collection was measured on computed tomography (CT) scans 1year after operation. Results: The CT scans of 115 patients were available; 56 had endarterectomy of the aneurysm sac and 59 did not. Fluid collections were significantly smaller in patients with endarterectomy (median width 4.0 versus 8.0mm; P=0.0001). Eight patients with endarterectomy had a fluid collection wider than 10mm compared to 28 patients without endarterectomy (OR 0.18, 95% CI 0.07-0.46). After endarterectomy, 17 patients had radiological signs of complete graft incorporation in comparison to only 6 patients without endarterectomy (OR 3.85, 95% CI 1.39-10.66). No patients were symptomatic or reoperated for perigraft seroma. Conclusions: Endarterectomy of the aneurysm sac in open AAA repair appears to improve graft incorporation. The high rate of asymptomatic perigraft seroma is surprising, and its clinical significance is unknown. Ultrafiltration of PTFE grafts may be an underlying mechanism