Biobond^® is highly effective for perigraft seroma formation in loop e-PTFE vascular grafts in patients with chronic renal failure

Abstract

Perigraft seroma formation is a difficult complication to treat in arterio-venous (AV) shunt using expanded polytetrafluproehylene (e-PTFE) vascular graft in patients with chronic renal failure (CRF). Seroma, which is a collection of traps-membrane exudate across the vascular access graft, is commonly treated by laser or an argon beam coagulator at the exudative sites and total or partial replacement of a vascular graft. We obtained good clinical results for perivascular seroma using Biobond^®. Biobond^® is a tissue adhesive that is mainly composed of methyl-2-cyanoacrylate. The adhesiveness of this material is firm and stable compared with the conventional tissue adhesive composed of fibrinogen and it is simple to use. The lesion is sprayed and immediately dried with a sterilized hair drier.
The first case was a 64-year-old man with CRF. Hemodialysis was started in June, 1975 using a left forearm AV shunt. Twenty-three years later, he underwent poly-surgery due to frequent internal AV shunt complications, followed by e-PTFE loop fistula between the left femoral artery and vein. He developed a swelling in the left inguinal region where the vascular anastomosis was present, which was diagnosed as a perigraft seroma. Surgery was performed using tissue adhesive composed of fibrinogen after completely removing the tumor, but the result was not satisfactory. We, therefore, reoperated using Biobond^®. The next case was a 65-year-old man with CRF with an 18-year history of hemodialysis. He underwent surgery due to perigraft seroma in the right inguinal portion where the AV shunt using e-PTFE vascular graft was present. We currently use Biobond^® primarily to prevent exudation across the graft based on our findings in the first case. No significant side effects or recurrence was seen during the postoperative days.
Our clinical study showed that Biobond^® has several advantages for the treatment of perivascular seroma in patients with chronic renal failure.