Treatment of Perigraft Seromas Complicating Hemodialysis Grafts with Greater Saphenous Vein Interposition

ABSTRACT

PURPOSE: Perigraft seromas are a collection of clear and sterile ultrafiltered serum, encased by a fibrous pseudocapsule or within a well-circumscribed gray sponge-like soft tissue mass (gelatinoma) that develops around a patent prosthetic vascular graft. Seromas are unusual complications of hemodialysis grafting with a high rate of recurrence and graft loss. There is no effective therapy for patients and multiple operations and graft replacements often are followed by unsatisfactory results. We successfully replaced the transducing prosthesis segment with the great saphenous vein. The purpose of this study was to review the treatment of perigraft seromas complicating hemodialysis grafts using great saphenous vein interposition. METHOD: We reviewed the records of eight patients who had treatment of a perigraft seroma complicating hemodialysis with the great saphenous vein from January 2005 to December 2006. RESULT: The mean age of the patients was 51 years and three patients had a history of diabetes mellitus. The PTFE graft was placed at the brachiobrachial (loop) position of the forearm in six patients. The affected site was the arterial anastomosis in all cases. In all cases, the transuding segment of the prosthesis was successfully replaced with the greater saphenous vein and excision of the pseudo-capsule. There was no recurrence. CONCLUSION: If rerouting of prosthetic material through a new anatomic route is difficult, treatment of perigraft seroma can be successfully achieved by the removal of the original graft and as much of the seroma as possible, including the pseudocapsule. The transducing proximal segment of the prosthesis at the arterial anastomosis was successfully replaced with a reversed greater saphenous vein, placed along the same route. This procedure resulted in resolution of the seroma with preservation of the original graft. This procedure was safe and effective for the treatment of perigraft seromas.