title: Postoperative fluid collection after hybrid debranching and endovascular repair of thoracoabdominal aortic aneurysms.
abstract: OBJECTIVE
  Hybrid thoracic endovascular aneurysm repair (H-TEVAR) to include visceral and renal debranching has emerged as a potential therapeutic option for thoracoabdominal aneurysms (TAAA). This study was performed to characterize the frequently noted development of postoperative fluid collections surrounding the bypass grafts.
  
  
  METHODS
  All patients undergoing H-TEVAR from 2000-2010 (n = 39, 43.6% male) were identified. One hundred thirty-two bypasses were constructed (median 4 per patient) using either polyester (30), thin-walled polytetrafluoroethylene (ePTFE, 100) or saphenous vein (2). Follow-up computed tomography (CT) imaging was routinely performed at 1 and 6 months, and annually thereafter.
  
  
  RESULTS
  Of the 37 patients with one follow-up CT, 20 (54.1%) were found to have fluid collections. The natural history of the 17 patients with collections and further follow-up imaging was variable, with 2 resolving, 6 stable, and 9 enlarging. Two patients with collections developed evidence of graft infection requiring reoperation. Two patients with enlarging sterile collections required evacuation for symptoms. By multivariate analysis, both preoperative creatinine (P = .005) and number of bypasses constructed (P = .04) independently correlated with the development of a fluid collection.
  
  
  CONCLUSIONS
  Postoperative fluid collections following hybrid debranching procedures identified in this series represent a unique complication not previously described. The subsequent clinical course of these fluid collections is variable and ranges from benign to frank graft infection and relate both to patient factors, as well as specific operative strategies. Longer-term studies with more robust numbers of patient numbers are warranted to determine whether this complication may limit the long-term durability of this procedure.
authors.affiliation: Department of Surgery, University of Michigan Cardiovascular Center, Ann Arbor, MI 48109-5864, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Hurie
authors.forename: Himanshu J
authors.initials: HJ
authors.lastname: Patel
authors.forename: Enrique
authors.initials: E
authors.lastname: Criado
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Eliason
authors.forename: G Michael
authors.initials: GM
authors.lastname: Deeb
authors.forename: Gilbert R
authors.initials: GR
authors.lastname: Upchurch
mesh_terms: D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D004487:Edema / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D057867:Endoleak / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D049291:Seroma / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D016896:Treatment Outcome