ORIGINAL ARTICLES  VASCULAR SECTION 

The Journal of Cardiovascular Surgery 2002 April;43(2):217-21

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Lymphoceles complicating arterial reconstructions of the lower limbs: outpatient conservative management

Porcellini M., Iandoli R., Spinetti F., Bracale U., Di Lella D.

From the Department of Vascular Surgery, Federico II University, Naples, Italy

Background. Treatment of lym­pho­celes com­pli­cat­ing vas­cu­lar pro­ce­dures is con­tro­ver­sial. The pur­pose of ­this ­study was to eval­u­ate the prac­ti­cabil­ity, effec­tive­ness and safe­ty of con­ser­va­tive man­age­ment on an out­pa­tient ­basis.
Methods. Medical ­records ­were ­reviewed for 23 post­op­er­a­tive lym­pho­celes (in 18 ­patients) ­seen at our insti­tu­tion ­between 1986 and 1999. Diagnosis was ­made by phys­i­cal exam­ina­tion and nee­dle aspi­ra­tion of ­fluid col­lec­tion; bac­te­ri­al cul­tures ­were ­obtained in all. Ultrasonography was per­formed in all ­patients, lym­phos­cin­tig­ra­phy (99mTc HSA) in 11, ­angio-TC in 2 cas­es, MRI in 3 ­large lym­pho­celes.
Results. Twenty-one lym­pho­celes devel­oped in the ­groin, 2 in the ­thigh and ­were most­ly (72.2%) diag­nosed ­after hos­pi­tal dis­charge. Imaging tech­niques detect­ed sub­cu­ta­ne­ous ­wound col­lec­tion; in addi­tion, lym­phos­cin­tig­ra­phy ­showed lym­phat­ic inter­rup­tion and col­lat­er­al path­ways in ­patients ­with ­limb swell­ing. Outpatient man­age­ment con­sist­ed of lim­it­ed ambu­la­tion, ­limb ele­va­tion and pres­sure dress­ings; no seri­al aspi­ra­tions ­were ­made. Resolution was ­obtained in all ­patients ­over a ­mean peri­od of 21 ­days (­range, 12 to 35). No ­patient ­required re-hos­pi­tal­iza­tion or devel­oped ­wound and/or ­graft infec­tion. No recur­rence was not­ed ­after a fol­low-up of all ­patients for 1 ­year.
Conclusions. Outpatient treat­ment of lym­pho­celes fol­low­ing arte­ri­al recon­struc­tive pro­ce­dures can be per­formed safe­ly. Significant advan­tag­es of ­this path­way ­include no re-hos­pi­tal­iza­tion and ­cost reduc­tion.