Thrombin Gel Matrix As A Novel Treatment For Lymphatic Fistula After Inguinal Approach In Minimally Invasive Cardiovascular Surgery

José Francisco Valderrama-Marcos^1,2, Alberto Martín-Palanca², Carmen Ramos-Cantos², Julia Fernández-Castañer¹, Ignacio Tribes-Caballero¹, Sergio González-González¹.

¹Hospital Regional Universitario de Málaga, Málaga, Spain | ²HospitalVithas Málaga, Málaga, Spain.

Background:

Postoperative lymphatic leakage is a rare but well-known phenomenon after inguinal approach in minimally invasive cardiovascular surgery. Although it is usually not severe, it generally increases pain, hospital stay, and the risk of dehiscence and surgical site infections. Thrombin gel matrix has been used in prevention but has not been reported for treatment. We describe its use for effective closure of a lymphatic fistula.

Methods:

A 78-year-old female underwent thoracic endoprosthesis via right transfemoral approach and femoro-popliteal bypass. 26 days later, she presented with lymphorrhagia. AngioCTshowed a lymphocele and fistula (Fig. 1A). After 10 days of conservative care, 5 ml of thrombin gel matrix was applied through the fistula into the lymphocele(Fig. 2)..

Results:

Lymphorrhagia ceased within 24 hours. VAC therapy began on day 3. Complete healing occurred 33 days after the thrombin application (Fig. 3). At 6-month follow-up, the patient isasymptomatic and shows no signs offistula or lymphocele on the control angioCT scan (Fig. 1 B).

Conclusions

Lv S, Wang Q, Zhao W, Han L, Wang Q, Batchu N, et al. A review of the postoperative leakage. Oncotarget. 2017;8(40):69062–69075.