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A hematoma can cause two problems. First, it can be a reason for early graft blockage due to extrinsic pressure. Secondly, even if it does not block your graft, it can cause severe damage to the muscles (especially on the calf muscles) and even on the skin; it can cause severe necrosis on the skin and the underlying muscle.
Have a look at the next image. On this 80-year-old male patient suffering from chronic renal failure on hemodialysis, we performed a successful popliteal-to-dorsalis pedis venous bypass graft. We used a small drain (size 12 or maybe less), it blocked on post-op day 1, and was removed on post-op day 2, but unfortunately a hematoma was created underneath the skin and caused this damage with no compromise on the graft flow.
So, there are two lessons: first, use a large-bore suction drain and leave it as long as it stops draining, and second, if a hematoma appears, you’d better take the patient into the OR and evacuate it properly and completely.