A COMPARISON OF CONSERVATIVE THERAPY AND EARLY SELECTIVE LIGATION IN THE TREATMENT OF LYMPHATIC COMPLICATIONS FOLLOWING VASCULAR PROCEDURES

BACKGROUND: Lymphatic leakage is a relatively uncommon but serious com plication following vascular procedures. A conservative approach consi sting of bed rest, leg elevation, prophylactic antibiotics, compressiv e dressings, and intermittent aspiration is the most commonly used tre atment. Because of the long time it takes to cure this condition and t he potential for infections, a more aggressive approach consisting of wound exploration and ligation of the leaking lymphatic has been propo sed. We review our experience of the past 3 years treating 17 of these complications by using 1 of these 2 approaches. PATIENTS AND METHODS: Seventeen groin complications were seen over a period of 3 years. Ten (59%)patients were treated by selective ligation assisted with isosul fan blue dye injection, and the remaining 7 (41%) were treated conserv atively. RESULTS: Mean hospital stay was 2.4 days (range 1 to 4) for t he operative group versus 19 days (range 14 to 42) for the conservativ e group. One complication was seen in the operative group, whereas 4 ( 57%) patients developed groin infections following conservative therap y. One (10%) patient developed a recurrence following ligation that wa s treated successfully by reoperation. CONCLUSION: Our experience with the use of surgical ligation of leaking lymphatic assisted by isosulf an blue, when compared with conservative treatment, has led to a decre ase in hospital stay, lower complication rates, and fewer recurrences. In our view, this approach represents the best form of treatment for postoperative groin lymphatic complications.