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Complications of femoropopliteal and infrapopliteal arterial bypass
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Frank M. Davis, Peter K. Henke
A lymphocele is a localized collection of lymph that develops between two planes of tissues and fails to be reabsorbed. In contrast to a seroma, a lymphocele usually has a well-localized connection with one or more of the lymphatic channels. For this reason, lymphoscintigraphy can readily demonstrate a lymphocele. The infrainguinal region represents the most common location for lymphoceles following vascular reconstruction. Large lymphoceles cause local discomfort, pain, and leg swelling. Hematoma, seroma, and wound infection should be considered in the differential diagnosis. The presence of a soft, fluid-filled cyst and intermittent drainage of clear lymph through a fistula confirms the diagnosis of lymphocele. Ultrasonography is helpful in distinguishing a solid, dense hematoma from a cystic lymphocele. CT is performed when a lymphocele develops several weeks to months after the operation. CT is helpful in excluding graft infection or identifying a retroperitoneal lymphocele extending to the groin. Regarding the management of lymphoceles, small lymphoceles can be monitored with a chance of slow reabsorption over time. In contrast, large lymphoceles or those within the vicinity of prosthetic graft should undergo surgical intervention to reduce the risk of graft infection. Injection of isosulfan blue into the foot is helpful for identifying the lymphatic channels supplying the lymphocele. The lymphocele is excised, and the lymphatic pedicle is ligated or oversewn. Sclerotherapy can also be used for groin lymphoceles but has mixed results.
Ultrasound-Guided Procedures in Gynecologic Oncology
Published in Juan Luis Alcázar, Ultrasound Assessment in Gynecologic Oncology, 2018
Lymphoceles are a complication occurring after lymphadenectomy (12). The incidence of postoperative lymphocele reported is wide, ranging from 1% to 58% (12). The diagnosis is relatively easy by ultrasound. A lymphocele is usually seen as a round or oval simple cyst running alongside pelvic iliac vessels or the aorta (Figure 10.8).
Infrainguinal bypass graft for lower extremity arterial occlusive disease
Published in Sachinder Singh Hans, Alexander D Shepard, Mitchell R Weaver, Paul G Bove, Graham W Long, Endovascular and Open Vascular Reconstruction, 2017
Frank M. Davis, Peter K. Henke
The CFA is most frequently used as the inflow vessel for infrainguinal bypasses. A vertical incision is made directly over the femoral pulse (Figure 49.2a). If a femoral pulse cannot be palpated, the CFA can be identified in the medial third between the pubic tubercle and the anterior superior iliac spine. The incision is deepened with electrocautery to the level of the deep fascia (Figure 49.2b), which is incised exposing the femoral sheath with the aid of self-retaining retractors (Figure 49.2c). Adequate time should be spent ligating all lymphatics to reduce the risk of a lymphocele. On entering the femoral sheath, the CFA is dissected proximally to the inguinal ligament. Distally, the CFA divides into the SFA and the profunda femoris artery. Exposure of these vessels is best accomplished by dissecting distally on the anterior surface of the parent trunk. The lateral femoral circumflex vein crosses anterior to the profunda femoris artery at the level of bifurcation (Figure 49.2d).
Wound healing adverse events in kidney transplant recipients receiving everolimus with reduced calcineurin inhibitor exposure or current standard-of-care: insights from the 24-month TRANSFORM study
Published in Expert Opinion on Drug Safety, 2020
Franco Citterio, Mitchell Henry, Dean Y Kim, Myoung Soo Kim, Duck-Jong Han, Takashi Kenmochi, Eytan Mor, Giuseppe Tisone, Peter Bernhardt, Maria Pilar Hernandez Gutierrez, Yoshihiko Watarai
The numerical difference between EVR+rCNI and MPA+sCNI treatments in terms of proportion of patients with at least 1 WHAE was particularly driven by the proportion of patients with lymphocele and wound dehiscence which was significantly higher in the EVR+rCNI group (7.5% vs. 5.1% and 3.9% vs. 1.8%, respectively). Symptomatic lymphocele and wound dehiscence may necessitate surgical intervention. This result is in accordance with earlier reports. In a pooled analysis including 1996 de no renal transplant recipients, the 12-month incidence of lymphocele reported as adverse event was 11.2% with EVR 1.5 mg and 8.9% with MPA. The overall incidence of wound dehiscence was 2.2% (frequency by treatment not reported) [7]. In a more recent open-label, randomized, parallel group study investigating EVR with reduced-exposure tacrolimus versus MPA with standard-exposure tacrolimus, the comparative incidence of lymphocele and wound dehiscence over the 12-month study period was 8.5% vs. 5.9% and 5.2% vs. 3.6%, respectively [4].
Can we predict the development of symptomatic lymphocele following robot-assisted radical prostatectomy and lymph node dissection? Results from a tertiary referral Centre
Published in Scandinavian Journal of Urology, 2020
Simone Sforza, Riccardo Tellini, Antonio Andrea Grosso, Claudia Zaccaro, Lorenzo Viola, Fabrizio Di Maida, Andrea Mari, Marco Carini, Andrea Minervini, Lorenzo Masieri
All patients had a standard six-port transperitoneal RARP as previously extensively reported in literature [6]. PLND was performed according to the preoperative 2012 Briganti nomogram [8]. We performed extended PLND including the nodes overlying the common and the external iliac artery and vein, those within the obturator fossa located cranially and caudally to the obturator nerve, and the nodes medial and lateral to the internal iliac artery. According to the surgeon’s preferences, lymphatic vessels were sealed using three different techniques: extensive use of clipping for both large and small vessels, clips only on main vessels or vessels cauterization with the bipolar instrument. The peritoneum was not closed in any case after PLND. Abdominal drainage was placed according to the surgeon’s choice and, if present, removed when the amount of lymph drained for a day (mL/24 h) was <50 mL. Postoperative ultrasound (US) examinations or CT scans were performed only in case of lymphocele suspicious, based on patient’s symptoms, or whether the drainage supplied more than 400 ml for three consecutive days.
End-to-end ureteroureteroanastomosis with unilateral nephrostomy: revival of a forgotten technique suitable for a modern context?
Published in Scandinavian Journal of Urology, 2019
Georg Jancke, Gediminas Baseckas, Johan Brändstedt, Petter Kollberg, Anne Sörenby, Fredrik Liedberg
Emergency hospital readmission within 90 days of surgery occurred in six patients; five of these readmissions were due to infectious complications, presenting as febrile urinary tract infections in four of the five patients. In three of these five patients, malfunction of the nephrostomy tube was responsible for readmission, and consecutive correction of the nephrostomy under fluoroscopic guidance in the radiology department was necessary in these individuals. In one of these five patients, a lymphocele requiring percutaneous drainage occurred. Another one of the infectious readmissions was due to urinary leakage causing a phlegmon, and one of the six readmitted patients required hospitalization due to severe macroscopic haematuria from the nephrostomy tube. Thus, complications according to the Clavien-Dindo classification occurred within 90 days in five patients as grade 3a and in one as a grade 3b complication due to an abscess in the inguinal region requiring acute surgical drainage. However, no grade 4 or 5 complication was recorded. Four patients died during further follow-up, three due to metastatic urinary bladder cancer and one due to cardiac failure.