Treatment of Perigraft Seroma in Arteriovenous Graft with Expanded PTFE for Hemodialysis by Using Vacuum Therapy

Nowadays, although the number of patients with end staged renal disease does not decrease and kidney transplantation is insufficient due to the limited organ donation, arteriovenous fistula for hemodialysis is the only treatment options for them.According to the patients' blood vessel condition, autologous vessels or artificial graft was selected for shunt and each had advantages and disadvantages.Since its introduction in 1975, gore-tex polytetrafluoroethylene grafts have been applied as an option for vascular access.Since then, various common complications have been introduced, such as thrombosis, infection, aneurysmal change, and steal syndrome.Bolton et al. firstly described the perigraft seroma in 1981 [1].Although perigraft seroma is an uncommon complication about 0.5-4.2%[2], it is a troublesome enough to risk graft loss.There are many cases that do not require special treatment due to spontaneous resolution of seroma [3], but aggressive treatments are required for swelling accompanied by a bursting sensation, continuous growth, wound problems, and cannulation problems.Serial aspiration, incision and drainage, cyst removal, and fibrin injection have been introduced as treatment methods, but there is no other treatment method that has been proven to be effective.In this case, we introduce the treatment using vacuum therapy for the resistant perigraft seroma.In this case, we introduce a case using vacuum therapy to the treatment of resistant perigraft seroma despite various treatments being tried. CASEThe patient was a 59-year-old man with end-stage renal disease on hemodialysis via permanent catheter for 4 months.He had diabetes mellitus and mental retardation.Previously, he had underwent open reduction and internal fixation due to right