GROIN LYMPHATIC COMPLICATIONS AFTER ARTERIAL RECONSTRUCTION

Purpose: The purpose of this study was to better define the associated risks and optimal management of groin lymphatic complications (GLC) a fter femoral artery reconstructive operations. Methods: Retrospective review of a vascular surgery registry for the last 15 years identified 2679 arterial operations requiring a groin incision. Forty-one GLC we re recognized, 28 lymphocutaneous fistulas (LE) and 13 lymphoceles. Re sults: The incidence of GLC was 1.5% per patient or 1.2% per incision. The highest incidence of GLC was in patients having an aortobifemoral bypass for aneurysmal disease in a previously operated groin (8.1% pe r patient) and in those undergoing an isolated femoral procedure in a previously operated groin (5.3%). The lowest frequency of GLC was afte r femoropopliteal/tibial bypasses (0.5%). Twenty-nine patients (71%) w ere treated without operation with bedrest, intravenous antibiotics, a nd aggressive local wound care. Operative therapy with wound reexplora tion attempted identification and control of the leak site, and meticu lous wound closure was used in 12 patients (29%). Lymph fistulas in pa tients undergoing reoperation (10/28) resolved sooner than in patients treated without operation (18/28) (9 +/- 3 days vs 24 +/- 3 days). In fectious wound complications with one resultant graft infection develo ped in five of 18 patients with LP who did not undergo reoperation. Th ere were no wound or graft infections in the patients in the LP group treated with operation. Operative exploration of lymphoceles did not r educe hospital stay or infectious wound complications. Repetitive lymp hocele aspiration did not affect rapidity of resolution or increase th e infectious complications. Conclusion: GLC remain a troublesome compl ication of femoral arterial reconstruction. Early reoperation should b e performed once a LP is diagnosed. Treatment for lymphoceles should b e individualized, with neither operative nor nonoperative management s howing clear superiority.