THE MANAGEMENT OF MASSIVE ULTRAFILTRATION DISTENDING THE ANEURYSM SACAFTER ABDOMINAL AORTIC-ANEURYSM REPAIR WITH A POLYTETRAFLUOROETHYLENEAORTOBIILIAC GRAFT

Collections of serous fluid surrounding prosthetic grafts can be cause d by infection or transudation of serum, and making the distinction is often troublesome. Bergamini and his colleagues(1) developed a dog mo del of low-grade prosthetic graft contamination with Staphylococcus ep idermatis. All animals developed evidence of graft infection, and 13 o f 18 dogs developed a fluid-filled perigraft cyst. Signs of systemic i nfection, however, were present in only 1 animal, and the Staphylococc us epidermatis study strain was isolated from the tissue surrounding t he graft in only 1 dog. The authors had to disrupt the biofilm to achi eve positive cultures in 14 of 18 animals. This animal model seemed to conform to clinical experience and placed great emphasis on the role of indolent infections in the pathogenesis of perigraft fluid collecti on. It is equally clear that perigraft fluid collections may result fr om transudation of fluid through the prosthetic surfaces, which act si milar to a dialysis membrane under certain circumstances.(2-6) Noninfe ctious seromas are characterized generally by the accumulation of clea r serous fluid with a protein and glucose content of serum and the lac k of acute inflammatory cells when the sediment is examined. The need to distinguish between these 2 forms of fluid accumulation became impo rtant in the treatment of a 62-year-old man who was seen 2 1/2 years a fter the repair of an abdominal aortic aneurysm with an aortobiiliac s tretch polytetrafluoroethylene (PTFE) prosthesis. There was no evidenc e of infection, and there was a 12 cm cystic mass surrounding a patent PTFE prosthesis.