CONSEQUENCES OF GROIN LYMPHATIC FISTULAS AFTER VASCULAR RECONSTRUCTION

Division of lymphatics during femoral arterial exposure may result in a lymphatic fistula. The management of this problem may be conservative or operative, both aimed at stopping the leak of lymphatic fluid and preventing graft contamination. The authors' purpose was to review their groin lymphatic fistulae over the last ten years to assess their approach and determine long-term outcome. Forty-five patients during the past ten years had an identified lymphatic fistula following vascular reconstruction involving the femoral artery. Sixty-seven percent had underlying prosthetic grafts at risk. Twenty-three patients were managed conservatively (bed rest, pressure dressing, antibiotics) with an average of thirteen days of lymphatic fistula and all resolved. In 22 patients the lymphatic fistula was stopped by exploration and simple closure after an average of fourteen days. The average length of stay after vascular surgery was sixteen days in patients treated conservatively, and twenty-four days in those treated surgically. There were 3 groin infections in the group treated conservatively. Follow-up of all patients averaged fifty-three months (range three to one hundred thirty-one months), and there was no evidence of false aneurysm formation or graft infection. Both conservative and operative approaches are effective in the management of the lymphatic leak, and the decision between the two methods of treatment depends upon drainage volume and duration.