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Medical Question TEVAR surgery complication

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Medical Question TEVAR surgery complication

Old 01-13-2010, 12:11 PM
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Default Medical Question TEVAR surgery complication

My mom underwent a surgery on Monday to implant a 19mm Dacron stent (sp?) in her Aeorta through her Femoral artery due to an anuerism just below the subclavian artery coming off her aeorta. Because the stent was expected to block the subclavian artery they also bypassed the blockage caused by the stent in a second procedure I belive called a subclavian cartoid arterial bypass.
All was successful on Monday and she was brought out of sedation from the anestesia @ 2 or 3 am Tuesday morning. The nurses were impressed with her recovery and she was up and talking and joking with the staff Tuesday morning. Several hours later the nurses in Recovery ICU removed some type of monitor tube from her incision for the subclavian cartoid arterial bypass.
A couple hours later a nurse noticed a large pooling of fluids under her skin just below the incision in her neck.
The Dr. thinks she may have knicked a Lymph node however she is unsure where exactly the leak is. She is producing 3 to 4 oz an hour of a yellowish clear fluid through a drainage tube in the incision. She said she may be able to insert some type of cream into the stomach to see where the leakage is occurring...
Any idea if the rupture/knick in the Lymph can be repaired? How? Should they consider removing the Lymph entirely? The Dr. has been in another surgery all this morning and when she is finished plans to reopen mom and try to identify and repair the leak.
Thanks in advance for any replies!
Sorry for any inaccuracies in the wordy post above.
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Old 01-13-2010, 02:34 PM
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Originally Posted by starmonk View Post
My mom underwent a surgery on Monday to implant a 19mm Dacron stent (sp?) in her Aeorta through her Femoral artery due to an anuerism just below the subclavian artery coming off her aeorta. Because the stent was expected to block the subclavian artery they also bypassed the blockage caused by the stent in a second procedure I belive called a subclavian cartoid arterial bypass.
All was successful on Monday and she was brought out of sedation from the anestesia @ 2 or 3 am Tuesday morning. The nurses were impressed with her recovery and she was up and talking and joking with the staff Tuesday morning. Several hours later the nurses in Recovery ICU removed some type of monitor tube from her incision for the subclavian cartoid arterial bypass.
A couple hours later a nurse noticed a large pooling of fluids under her skin just below the incision in her neck.
The Dr. thinks she may have knicked a Lymph node however she is unsure where exactly the leak is. She is producing 3 to 4 oz an hour of a yellowish clear fluid through a drainage tube in the incision. She said she may be able to insert some type of cream into the stomach to see where the leakage is occurring...
Any idea if the rupture/knick in the Lymph can be repaired? How? Should they consider removing the Lymph entirely? The Dr. has been in another surgery all this morning and when she is finished plans to reopen mom and try to identify and repair the leak.
Thanks in advance for any replies!
Sorry for any inaccuracies in the wordy post above.
Hello Starmonk,

A seroma forms in neck (cervical wounds) incisions because of either weepage around raw areas (Serum) Or lymph drainage. There are lot's of lymph nodes in the neck and the lymph ducts in the neck are often disrupted causing lymph leaks. The third serous drainage that's possible occurs on the left side only. The thoracic duct drains chyle from the gut to the left subclavian vein. Chyle is milky fluid. A thoracic duct leak is a bigger problem. You did not specify what side of the neck (there's a subclavian artery on each side) so only you can know if the thoracic duct may or may not be involved.

Lymph leaks can eventually stop. If it doesn't, don't be surprised if the surgeons recommend opening the wound and doing a surgical exporation and attempting to find the source of the leak. This type of operation is commonly done in chasing down sentinal nodes that drain melanoma and certain cancers. Radioactive dye can be infused and a geiger counter type device can be useful to trace the lymph flow. Suspect nodes can also be removed. Lymph duct anatomy is highly variable and finding "the" duct may prove to be very difficult. Get the last word from the surgeons. They are the pro's and better than any internet guru.

The worse thing that can happen is to prevent cutaneous drainage. The fluid will form an evenutal large seroma that can obstruct the airway and carotids. Better to have drainage than allowing the fluid to collect under the skin.

Good luck to your loved one. This situation will resolve.
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Old 01-14-2010, 05:20 AM
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Thanks a million Doc! The only reason I went to the "internet gurus" is 'cuz we were unable to talk it over with the surgeon...The incision was on the left side. The exploratory surgery as you described above was done late yesterday and the suspect leak was identified and stitched. The surgeon said she was the cause of the knick that caused the drainage. They plan now to keep a close eye on it to ensure no further leaking occurs. If they continue to see leakage they intend to go in thru the foot and carterize it to close it up.
Again, thanks so much for your response!
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