title: Endarterectomy of the aneurysm sac in open abdominal aortic aneurysm repair reduces perigraft seroma and improves graft incorporation.
abstract: 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.
  
  
  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 1 year 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 8.0 mm; P = 0.0001). Eight patients with endarterectomy had a fluid collection wider than 10 mm 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.
authors.affiliation: Department of Vascular Surgery, Basel University Hospital, Spitalstrasse 21, 4031, Basel, Switzerland. wolfft@uhbs.ch
authors.forename: Thomas
authors.initials: T
authors.lastname: Wolff
authors.forename: Michael T
authors.initials: MT
authors.lastname: Koller
authors.forename: Thomas
authors.initials: T
authors.lastname: Eugster
authors.forename: Christophe
authors.initials: C
authors.lastname: Rouden
authors.forename: Regula
authors.initials: R
authors.lastname: Marti
authors.forename: Lorenz
authors.initials: L
authors.lastname: Gürke
authors.forename: Peter
authors.initials: P
authors.lastname: Stierli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D016001:Confidence Intervals; D017558:Elective Surgical Procedures / Q000379:methods*; D004691:Endarterectomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007813:Laparotomy / Q000379:methods; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011138:Polytetrafluoroethylene / Q000494:pharmacology; D011183:Postoperative Complications / Q000517:prevention & control; D018570:Risk Assessment; D049291:Seroma / Q000517:prevention & control*; D017131:Thrombectomy / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods
chemical_list: D011138:Polytetrafluoroethylene