Percutaneous Afferent Lymphatic Vessel Sclerotherapy for Postoperative Lymphatic Leakage After Previous Ineffective Therapeutic Transpedal Lymphangiography

Overview

Journal Eur Radiol Exp

Date 2020 Nov 2

PMID 33135104

Citations 5

Authors

F Pan

M Loos

T D Do

G M Richter

H U Kauczor

T Hackert

C M Sommer

Affiliations

Soon will be listed here.

Abstract

Background: To demonstrate the efficacy of percutaneous computed tomography (CT)-guided afferent lymphatic vessel sclerotherapy (ALVS) in the treatment of postoperative lymphatic leakage (LL) after ineffective therapeutic transpedal lymphangiography (TL).

Methods: A retrospective review in this institute involving 201 patients was conducted from May 2011 to September 2018. Patients diagnosed with postoperative LL undergoing ineffective therapeutical TL before the performance of percutaneous CT-guided ALVS were involved. Technical success and clinical success of TL and ALVS were established. The technical success and efficacy of ALVS in the treatment of postoperative LL after ineffective therapeutic TL were assessed. The clinical success rate of ALVS is also assessed, and the complications are reviewed.

Results: In total, nine patients were involved including three patients (33.3%) presented with chylothorax, three patients (33.3%) presented with inguinal lymphatic fistula/lymphocele, and three patients (33.3%) presented with lymphatic fistula in the thigh; 27 ± 18 days (mean ± standard deviation) after surgery, therapeutic TL was successfully performed and showed definite afferent lymphatic vessel and leakage site in all the patients. Due to clinical failure after TLs, the following ALVS was performed with a mean interval of 12 ± 8 days after TL. The technical success rate was 9/9 (100.0%, 95% confidence interval [CI] 63.1-100.0%). An average of 2.7 ± 1.3 mL 95% ethanol as sclerosant agent was injected during the procedure. The clinical success was observed in 8 of the 9 patients (88.9%, 95% CI 51.8-99.7%) with a time between ALVS and the LL cure of 8 ± 6 days. No complications were reported.

Conclusions: Our results showed the role of percutaneous CT-guided ALVS as a safe, feasible, and effective salvage treatment for postoperative LL after ineffective TL.

Citing Articles

Intranodal lymphangiography combined with foam sclerotherapy embolization of thoracic duct in the treatment of postoperative chylous leakage for thyroid carcinoma: a case report and review.

Liu R, Cao L, Du J, Xie P Front Radiol. 2024; 4:1476227.

PMID: 39399395 PMC: 11470440. DOI: 10.3389/fradi.2024.1476227.

Refractory massive chylothorax following robot-assisted laparoscopic splenectomy with pericardial devascularization treated with trans-jugular intrahepatic portosystemic shunt: a case report.

Deng X, Xia J Front Med (Lausanne). 2024; 11:1420157.

PMID: 39296890 PMC: 11408172. DOI: 10.3389/fmed.2024.1420157.

Standardizing lymphangiography and lymphatic interventions: a preclinical in vivo approach with detailed procedural steps.

Pan F, Do T, Schmitt N, Vollherbst D, Mohlenbruch M, Tinoush P CVIR Endovasc. 2023; 6(1):21.

PMID: 36995443 PMC: 10063775. DOI: 10.1186/s42155-023-00364-z.

Resolution of large pelvic lymphocele after incidental intracystic hemorrhage caused by percutaneous catheter drainage: Case report.

Nio A, Okadome M, Shimamoto K, Sonoda K, Saito T J Obstet Gynaecol Res. 2022; 48(4):1050-1054.

PMID: 35108750 PMC: 9302703. DOI: 10.1111/jog.15178.

Radiological management of postoperative lymphorrhea.

Sommer C, Pieper C, Offensperger F, Pan F, Killguss H, Koninger J Langenbecks Arch Surg. 2021; 406(4):945-969.

PMID: 33844077 DOI: 10.1007/s00423-021-02094-z.

References

Liu D, Shao Y, Shi J . Unilateral pedal lymphangiography with non-contrast computerized tomography is valuable in the location and treatment decision of idiopathic chylothorax. J Cardiothorac Surg. 2014; 9:8. PMC: 3904686. DOI: 10.1186/1749-8090-9-8. View

Majdalany B, Khayat M, Downing T, Killoran T, El-Haddad G, Khaja M . Lymphatic interventions for isolated, iatrogenic chylous ascites: A multi-institution experience. Eur J Radiol. 2018; 109:41-47. DOI: 10.1016/j.ejrad.2018.10.019. View

Nadolski G, Chauhan N, Itkin M . Lymphangiography and Lymphatic Embolization for the Treatment of Refractory Chylous Ascites. Cardiovasc Intervent Radiol. 2017; 41(3):415-423. DOI: 10.1007/s00270-017-1856-1. View

Yannes M, Shin D, McCluskey K, Varma R, Santos E . Comparative Analysis of Intranodal Lymphangiography with Percutaneous Intervention for Postsurgical Chylous Effusions. J Vasc Interv Radiol. 2017; 28(5):704-711. DOI: 10.1016/j.jvir.2016.12.1209. View

Plotnik A, Foley P, Koukounaras J, Lyon S . How I do it: Lymphangiography. J Med Imaging Radiat Oncol. 2010; 54(1):43-6. DOI: 10.1111/j.1754-9485.2010.02135.x. View

Yoshimatsu R, Yamagami T, Miura H, Matsumoto T . Prediction of therapeutic effectiveness according to CT findings after therapeutic lymphangiography for lymphatic leakage. Jpn J Radiol. 2013; 31(12):797-802. DOI: 10.1007/s11604-013-0252-2. View

Itkin M, Kucharczuk J, Kwak A, Trerotola S, Kaiser L . Nonoperative thoracic duct embolization for traumatic thoracic duct leak: experience in 109 patients. J Thorac Cardiovasc Surg. 2010; 139(3):584-89. DOI: 10.1016/j.jtcvs.2009.11.025. View

Sacks D, McClenny T, Cardella J, Lewis C . Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol. 2003; 14(9 Pt 2):S199-202. DOI: 10.1097/01.rvi.0000094584.83406.3e. View

Xu K, Hu X, Tian X, Gui Y, Wang L, Li L . [Clinical analysis of 123 cases of chylous effusion]. Zhonghua Yi Xue Za Zhi. 2011; 91(7):464-8. View

10.

Hill H, Srinivasa R, Gemmete J, Hage A, Bundy J, Beecham Chick J . Endolymphatic Ethiodized Oil Intranodal Lymphangiography and Cyanoacrylate Glue Embolization for the Treatment of Postoperative Lymphatic Leak After Robot-Assisted Laparoscopic Pelvic Resection. J Endourol Case Rep. 2018; 4(1):66-71. PMC: 5961458. DOI: 10.1089/cren.2018.0026. View

11.

Kim S, Hur S, Kim S, Cho J, Kwak C, Kim H . The Efficacy of Lymph Node Embolization Using N-Butyl Cyanoacrylate Compared to Ethanol Sclerotherapy in the Management of Symptomatic Lymphorrhea after Pelvic Surgery. J Vasc Interv Radiol. 2019; 30(2):195-202.e1. DOI: 10.1016/j.jvir.2018.09.038. View

12.

Hur S, Shin J, Lee I, Min S, Min S, Ahn S . Early Experience in the Management of Postoperative Lymphatic Leakage Using Lipiodol Lymphangiography and Adjunctive Glue Embolization. J Vasc Interv Radiol. 2016; 27(8):1177-1186.e1. DOI: 10.1016/j.jvir.2016.05.011. View

13.

Reisenauer J, Puig C, Reisenauer C, Allen M, Bendel E, Cassivi S . Treatment of Postsurgical Chylothorax. Ann Thorac Surg. 2017; 105(1):254-262. DOI: 10.1016/j.athoracsur.2017.07.021. View

14.

Cahill A, Nijs E, Ballah D, Rabinowitz D, Thompson L, Rintoul N . Percutaneous sclerotherapy in neonatal and infant head and neck lymphatic malformations: a single center experience. J Pediatr Surg. 2011; 46(11):2083-95. DOI: 10.1016/j.jpedsurg.2011.07.004. View

15.

Lee E, Shin J, Ko H, Park J, Kim S, Sung K . Lymphangiography to treat postoperative lymphatic leakage: a technical review. Korean J Radiol. 2014; 15(6):724-32. PMC: 4248627. DOI: 10.3348/kjr.2014.15.6.724. View

16.

Alejandre-Lafont E, Krompiec C, Rau W, Krombach G . Effectiveness of therapeutic lymphography on lymphatic leakage. Acta Radiol. 2011; 52(3):305-11. DOI: 10.1258/ar.2010.090356. View

17.

Gruber-Rouh T, Naguib N, Lehnert T, Harth M, Thalhammer A, Beeres M . Direct lymphangiography as treatment option of lymphatic leakage: indications, outcomes and role in patient's management. Eur J Radiol. 2014; 83(12):2167-2171. DOI: 10.1016/j.ejrad.2014.09.013. View

18.

Smolock A, Nadolski G, Itkin M . Intranodal Glue Embolization for the Management of Postsurgical Groin Lymphocele and Lymphorrhea. J Vasc Interv Radiol. 2018; 29(10):1462-1465. DOI: 10.1016/j.jvir.2018.04.020. View

19.

Cope C, Kaiser L . Management of unremitting chylothorax by percutaneous embolization and blockage of retroperitoneal lymphatic vessels in 42 patients. J Vasc Interv Radiol. 2002; 13(11):1139-48. DOI: 10.1016/s1051-0443(07)61956-3. View

20.

Chu H, Shin J, Kim J, Noh S, Yang W, Park S . Lymphangiography and Lymphatic Embolization for the Management of Pelvic Lymphocele After Radical Prostatectomy in Prostatic Cancer. Cardiovasc Intervent Radiol. 2019; 42(6):873-879. DOI: 10.1007/s00270-019-02209-6. View