Rutherford's 054: Local Complications: Lymphatic скачать в хорошем качестве

Rutherford's 054: Local Complications: Lymphatic

#VascularSurgery #LymphaticComplications #PostOpEdema #Lymphocele #LymphaticFistula #ChylousAscites #Chylothorax #SurgicalTechnique #RutherfordVascular This video transcript explores lymphatic complications following vascular surgery, highlighting issues beyond major arteries and veins. A common complication is leg swelling (edema) after lower leg bypass surgery (infranquinal reconstruction), affecting 50% to 100% of patients. This swelling typically appears upon resuming activity and often resolves within two to three months, although it can be persistent. The cause is an imbalance between fluid production and lymphatic drainage capacity. Improved blood flow post-surgery increases lymphatic load, but the more significant factor is reduced lymphatic transport due to injury or blockage of delicate lymphatic channels during dissection, particularly in areas like the groin, behind the knee, or along vein harvest sites. Evidence supporting this includes studies showing blood flow recovery precedes edema resolution and lymphangiography demonstrating significantly fewer functioning lymph vessels after bypass. Surgical technique greatly impacts risk; careful dissection preserving lymphatics dramatically reduces edema rates. Other potential complications include lymphatic fistulas, which are active leaks of lymphatic fluid, most commonly in the groin after vascular reconstruction. These are less common than edema (0.1-6.4%) and are often caused by failure to ligate divided vessels or poor wound healing. Diagnosis is typically based on persistent clear/yellow drainage, and management starts conservatively with wound care, rest, and elevation, progressing to surgical repair if high-volume or persistent, often using blue dye to locate the leak. Lymphoceles are contained collections of lymph fluid, often appearing within a month post-surgery. They cause groin discomfort or swelling. Ultrasound helps differentiate them from hematomas or seromas. Small, asymptomatic lymphoceles may resolve spontaneously, but larger or symptomatic ones, especially near a graft, usually require intervention like aspiration, sclerotherapy, or surgical excision with ligation of feeding vessels. Deeper complications include retroperitoneal lymphoceles, rare after standard aortic surgery but more frequent post-kidney transplant. Symptoms are vague (bloating, pain), and diagnosis relies on CT scans. Management ranges from observation to aspiration, sclerotherapy, or surgical drainage/ligation, with peritoneal fenestration common for transplant cases. Chylous ascites is a rare but serious leak of fat-rich lymph into the abdominal cavity after aortic surgery. It causes malnutrition and immune issues. Diagnosis is confirmed by fluid analysis via paracentesis. Treatment involves reducing chyle flow via diet (low-fat, MCTs) or TPN, and potentially surgical exploration to ligate the leak or using laparoscopic techniques. Chylothorax, chyle in the chest, is uncommon after vascular procedures. It presents with fluid buildup seen on imaging. Diagnosis requires fluid analysis. Management includes reducing chyle flow (diet, TPN) and draining the fluid (chest tube). Persistent high output may require surgical ligation of the thoracic duct, often via VATS. Prevention of all these issues relies on meticulous surgical technique, awareness of lymphatic anatomy, and careful ligation of divided lymphatic vessels during procedures. Understanding these potential lymphatic issues provides a more complete picture of recovery after vascular surgery.