The Ohio State University, Division of Nephrology, 395 W 12 the Avenue, Ground Floor, Columbus, Ohio 43210, USA

 
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1An end stage renal disease patient with a left forearm brachio-basilic arteriovenous graft who developed a golf ball size seroma 3-weeks after graft placement. Note a clear serous discharge upon gentle compression (marked by red circle).Click image to enlarge.

Introduction

Seroma is a complication unique to prosthetic arteriovenous graft (AVG), resulting as a consequence of transudation of sterile and clear serum, which is confined by a non-secretory fibrous pseudomembrane [1]. Although the precise etiology remains elusive, it is thought to be related to failure of the surrounding connective tissue to incorporate the graft [2]. The incidence of 2-4% reported in literature may not be a true representation due to frequently seen spontaneous resolution of seroma [2]. A seroma is typically located close to the arterial anastomosis and usually occurs within the first month after placement of the AVG [3] (Fig. 1). Ultrasound-guided needle aspiration of the fluid yielding serous or gelatinous material can be of both diagnostic and therapeutic significance. When in doubt, the fluid should be submitted for white blood cell count and bacterial evaluation. Treatment options include serial aspirations, surgical evacuation with or without drain placement, graft wrapping with microfibrillar collagen and surgical excision of the entire seroma with tissue debridement while leaving the graft in situ [1]. However, recurrence is not uncommon and a total graft excision and placement of a new conduit may rarely be necessary [1]. Although, it is a non-infectious process initially, repeated intervention can lead to secondary infection and access loss. Besides unsightliness, if left untreated, it can lead to wound infection, skin necrosis, graft thrombosis, or loss of the available cannulation area [2].

Acknowledgement

Declared none.

Conflict of Interest

The author confirms that this article content has no conflict of interest.

References

[1] Padberg FT, Calligaro KD, Sidawy AN. Complications of arteriovenous hemodialysis access: recognition and management. J Vasc Surg 2008; 48: 55S-80S.
[2] Shah et al. Dauria DM, Dyk P, Garvin P. Incidence and management of seroma after arteriovenous graft placement. J Am Coll Surg 2006; 203:506-11.
[3] Eid A, Lyass S. Acute perigraft seroma simulating anastomotic bleeding of a PTFE graft applied as an arteriovenous shunt for hemodialysis. Ann Vasc Surg 1996; 10: 290-1.

*Address correspondence to this author at the Division of Nephrology, The Ohio State University, 395 W 12 the Avenue, Ground Floor, Columbus, Ohio 43210, USA; Tel: 614 293 6839; E-mail: [email protected]

This material is adapated with permission from The Open Urology & Nephrology Journal

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