https://doi.org/10.4081/vl.2024.12826
Postoperative groin lymphocele: an overview of old and new therapeutical strategies
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 11 November 2024
Lymphatic complications (lymphoma and lymphorrae) following vascular access or interventions in the groin are frequently benign but may increase the risk of wound infection, need for reintervention, and prolong the length of the hospital stay.
Several management strategies have been developed so far, including percutaneous drainage, chemical sclerotherapy, and surgery, but a validated treatment algorithm has yet to be established in the current literature.
In this paper, the authors investigated the indications and outcomes of currently available strategies for treating groin lymphocele following surgical dissection of the femoral vessels and suggested an algorithm for treating this potentially severe complication.
Downloads
Pisani A, Braham W, Brega C, et al. Right axillary artery cannulation for venoarterial extracorporeal membrane oxygenation: a retrospective single centre observational study. Eur J Cardiothorac Surg. 2021;59:601-9. DOI: https://doi.org/10.1093/ejcts/ezaa397
Roberts JR, Walters GK, Zenilman ME, Jones CE. Groin lymphorrhea complicating revascularization involving the femoral vessels. Am J Surg. 1993;165:341-4. DOI: https://doi.org/10.1016/S0002-9610(05)80839-6
Cnotliwy M, Gutowski P, Petriczko W, Turowski R. Doxycycline treatment of groin lymphatic fistulae following arterial reconstruction procedures. Eur J Vasc Endovasc Surg. 2001;21:469-70. DOI: https://doi.org/10.1053/ejvs.2001.1327
Shermak MA, Yee K, Wong L, et al. Surgical management of groin lymphatic complications after arterial bypass surgery. Plast Reconstr Surg. 2005;115:1954-62. DOI: https://doi.org/10.1097/01.PRS.0000165069.15384.E5
Sansone F, del Ponte S, Zingarelli E, Casabona R. The ‘packing of the groin’ technique: an innovative approach for groin lymphocele. Interact Cardiovasc Thorac Surg. 2011;13:367-9. DOI: https://doi.org/10.1510/icvts.2011.276774
Boccardo F, Dessalvi S, Campisi C, et al. Microsurgery for groin lymphocele and lymphedema after oncologic surgery. Microsurgery. 2014;34:10-3. DOI: https://doi.org/10.1002/micr.22129
Ploeg AJ, Lardenoye JW, Peeters MP, et al. Wound complications at the groin after peripheral arterial surgery sparing the lymphatic tissue: a double-blind randomized clinical trial. Am J Surg. 2009;197:747-51. DOI: https://doi.org/10.1016/j.amjsurg.2008.04.014
Swinnen J, Chao A, Tiwari A, et al. Vertical or transverse incisions for access to the femoral artery: a randomized control study. Ann Vasc Surg. 2010;24:336-41. DOI: https://doi.org/10.1016/j.avsg.2009.07.020
Twine CP, Lane IF, Williams IM. Management of lymphatic fistulas after arterial reconstruction in the groin. Ann Vasc Surg. 2013;27:1207-15. DOI: https://doi.org/10.1016/j.avsg.2013.01.003
Salna M, Takayama H, Garan AR, et al. Incidence and risk factors of groin lymphocele formation after venoarterial extracorporeal membrane oxygenation in cardiogenic shock patients. J Vasc Surg. 2018;67:542-8. DOI: https://doi.org/10.1016/j.jvs.2017.05.127
White I, Mills JK, Diggs B, et al. Sentinel lymph node biopsy for melanoma: comparison of lymphocele rates by surgical technique. Am Surg. 2013;79:388-92. DOI: https://doi.org/10.1177/000313481307900428
Caiati JM, Kaplan D, Gitlitz D, et al. The value of the oblique groin incision for femoral artery access during endovascular procedures. Ann Vasc Surg. 2000;14:248-53. DOI: https://doi.org/10.1007/s100169910042
Smolock AR, Nadolski G, Itkin M. Intranodal Glue Embolization for the Management of Postsurgical Groin Lymphocele and Lymphorrhea. J Vasc Interv Radiol. 2018;29:1462-5. DOI: https://doi.org/10.1016/j.jvir.2018.04.020
Giovannacci L, Renggli JC, Eugster T, et al. Reduction of groin lymphatic complications by application of fibrin glue: preliminary results of a randomized study. Ann Vasc Surg. 2001;15:182-5. DOI: https://doi.org/10.1007/s100160010049
Borghese O, Pisani A, Di Centa I. Endovenous radiofrequency for chronic superficial venous insufficiency: Clinical outcomes and impact in quality of life. J Med Vasc. 2021;46:3-8. DOI: https://doi.org/10.1016/j.jdmv.2020.11.003
Tyndall SH, Shepard AD, Wilczewski JM, et al. Groin lymphatic complications after arterial reconstruction. J Vasc Surg. 1994;19:858-63. DOI: https://doi.org/10.1016/S0741-5214(94)70011-7
Ozawa M, Yamamoto M, Yamada K, et al. Intranodal Embolization for Groin Lymphocele. Interv Radiol (Higashimatsuyama). 2021;6:117-21. DOI: https://doi.org/10.22575/interventionalradiology.2020-0034
Srinivasa RN, Chick JFB, Patel N, et al. Transinguinal interstitial (intranodal) lymphatic embolization to treat high-output postoperative lymphocele. J Vasc Surg Venous Lymphat Disord. 2018;6:373-5. DOI: https://doi.org/10.1016/j.jvsv.2018.01.005
Scaglioni MF, Meroni M, Fritsche E. Lymphovenous anastomosis (LVA) for treatment of iatrogenic lymphocele in the thigh. Microsurgery. 2021;41:19-25. DOI: https://doi.org/10.1002/micr.30594
Herrera FA, Kohanzadeh S, Nasseri Y, et al. Management of vascular graft infections with soft tissue flap coverage: improving limb salvage rates—a veterans affairs experience. J Am Surg. 2009;75:877-81. DOI: https://doi.org/10.1177/000313480907501003
Sladen JG, Thompson RP, Brosseuk DT, et al. Sartorius myoplasty in the treatment of exposed arterial grafts. Cardiovasc Surg. 1993;1:113. DOI: https://doi.org/10.1177/096721099300100205
Illig KA, Alkon JE, Smith A, et al. Rotational muscle flap closure for acute groin wound infections following vascular surgery. Ann Vasc Surg. 2004;18:661-8. DOI: https://doi.org/10.1007/s10016-004-0105-7
Van den Brande P, von Kemp K, Aerden D, et al. Treatment of lymphocutaneous fistulas after vascular procedures of the lower limb: accurate wound reclosure and 3 weeks of consistent and continuing drainage. Ann Vasc Surg. 2012;26:833-8. DOI: https://doi.org/10.1016/j.avsg.2012.02.009
Schwartz MA, Schanzer H, Skladany M, et al. A comparison of conservative therapy and early selective ligation in the treatment of lymphatic complications following vascular procedures. Am J Surg. 1995;170:206-8. DOI: https://doi.org/10.1016/S0002-9610(99)80287-6
Mahrer A, Ramchandani P, Trerotola SO, et al. Sclerotherapy in the management of postoperative lymphocele. J Vasc Interv Radiol. 2010;21:1050-3. DOI: https://doi.org/10.1016/j.jvir.2010.03.014
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
