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01-06-2021 | Review Article

Radiological management of postoperative lymphorrhea

Authors: C. M. Sommer, C. C. Pieper, F. Offensperger, F. Pan, H. J. Killguss, J. Köninger, M. Loos, T. Hackert, M. Wortmann, T. D. Do, G. Maleux, G. M. Richter, H. U. Kauczor, J. Kim, S. Hur

Published in: Langenbeck's Archives of Surgery | Issue 4/2021

Abstract

Purpose

Postoperative lymphorrhea can occur after different surgical procedures and may prolong the hospital stay due to the need for specific treatment. In this work, the therapeutic significance of the radiological management of postoperative lymphorrhea was assessed and illustrated.

Method

A standardized search of the literature was performed in PubMed applying the Medical Subject Headings (MeSH) term “lymphangiography.” For the review, the inclusion criterion was “studies with original data on Lipiodol-based Conventional Lymphangiography (CL) with subsequent Percutaneous Lymphatic Intervention (PLI).” Different exclusion criteria were defined (e.g., studies with <15 patients). The collected data comprised of clinical background and indications, procedural aspects and types of PLI, and outcomes. In the form of a pictorial essay, each author illustrated a clinical case with CL and/or PLI.

Results

Seven studies (corresponding to evidence level 4 [Oxford Centre for Evidence-Based Medicine]) accounting for 196 patients were included in the synthesis and analysis of data. Preceding surgery resulting in postoperative lymphorrhea included different surgical procedures such as extended oncologic surgery or vascular surgery. Central (e.g., chylothorax) and peripheral (e.g., lymphocele) types of postoperative lymphorrhea with a drainage volume of 100–4000 ml/day underwent CL with subsequent PLI. The intervals between “preceding surgery and CL” and between “CL and PLI” were 2–330 days and 0–5 days, respectively. CL was performed before PLI to visualize the lymphatic pathology (e.g., leakage point or inflow lymph ducts), applying fluoroscopy, radiography, and/or computed tomography (CT). In total, seven different types of PLI were identified: (1) thoracic duct (or thoracic inflow lymph duct) embolization, (2) thoracic duct (or thoracic inflow lymph duct) maceration, (3) leakage point direct embolization, (4) inflow lymph node interstitial embolization, (5) inflow lymph duct (other than thoracic) embolization, (6) inflow lymph duct (other than thoracic) maceration, and (7) transvenous retrograde lymph duct embolization. CL-associated and PLI-associated technical success rates were 97–100% and 89–100%, respectively. The clinical success rate of CL and PLI was 73–95%. CL-associated and PLI-associated major complication rates were 0–3% and 0–5%, respectively. The combined CL- and PLI-associated 30-day mortality rate was 0%, and the overall mortality rate was 3% (corresponding to six patients). In the pictorial essay, the spectrum of CL and/or PLI was illustrated.

Conclusion

The radiological management of postoperative lymphorrhea is feasible, safe, and effective. Standardized radiological treatments embedded in an interdisciplinary concept are a step towards improving outcomes.

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Lv S, Wang Q, Zhao W et al (2017) A review of the postoperative lymphatic leakage. Oncotarget 8:69062–69075. https://doi.org/10.18632/oncotarget.17297CrossRefPubMedPubMedCentral

Inoue M, Nakatsuka S, Yashiro H, Tamura M, Suyama Y, Tsukada J, Ito N, Oguro S, Jinzaki M (2016) Lymphatic intervention for various types of lymphorrhea: access and treatment. Radiographics 36:2199–2211. https://doi.org/10.1148/rg.2016160053CrossRefPubMed

Kim PH, Tsauo J, Shin JH (2018) Lymphatic interventions for chylothorax: a systematic review and meta-analysis. J Vasc Interv Radiol 29:194–202 e4. https://doi.org/10.1016/j.jvir.2017.10.006CrossRefPubMed

Kos S, Haueisen H, Lachmund U, Roeren T (2007) Lymphangiography: forgotten tool or rising star in the diagnosis and therapy of postoperative lymphatic vessel leakage. Cardiovasc Interv Radiol 30:968–973. https://doi.org/10.1007/s00270-007-9026-5CrossRef

Alejandre-Lafont E, Krompiec C, Rau WS, Krombach GA (2011) Effectiveness of therapeutic lymphography on lymphatic leakage. Acta Radiol 52:305–311. https://doi.org/10.1258/ar.2010.090356CrossRefPubMed

Kortes N, Radeleff B, Sommer CM, Bellemann N, Ott K, Richter GM, Kauczor HU, Stampfl U (2014) Therapeutic lymphangiography and CT-guided sclerotherapy for the treatment of refractory lymphatic leakage. J Vasc Interv Radiol 25:127–132. https://doi.org/10.1016/j.jvir.2013.10.011CrossRefPubMed

Guez D, Nadolski GJ, Pukenas BA, Itkin M (2014) Transhepatic lymphatic embolization of intractable hepatic lymphorrhea. J Vasc Interv Radiol 25:149–150. https://doi.org/10.1016/j.jvir.2013.09.002CrossRefPubMed

Gaba RC, Owens CA, Bui JT, Carrillo TC, Knuttinen MG (2011) Chylous ascites: a rare complication of thoracic duct embolization for chylothorax. Cardiovasc Interv Radiol 34(Suppl 2):S245–S249. https://doi.org/10.1007/s00270-010-9900-4CrossRef

Nadolski GJ, Itkin M (2018) Lymphangiography and thoracic duct embolization following unsuccessful thoracic duct ligation: Imaging findings and outcomes. J Thorac Cardiovasc Surg 156:838–843. https://doi.org/10.1016/j.jtcvs.2018.02.109CrossRefPubMed

10.

Itkin M, Kucharczuk JC, Kwak A, Trerotola SO, Kaiser LR (2010) Nonoperative thoracic duct embolization for traumatic thoracic duct leak: experience in 109 patients. J Thorac Cardiovasc Surg 139:584–589; discussion 589–90. https://doi.org/10.1016/j.jtcvs.2009.11.025CrossRefPubMed

11.

Pieper CC, Hur S, Sommer CM, Nadolski G, Maleux G, Kim J, Itkin M (2019) Back to the future: Lipiodol in lymphography-from diagnostics to theranostics. Invest Radiol 54:600–615. https://doi.org/10.1097/RLI.0000000000000578CrossRefPubMed

12.

Tanaka K, Ohmori Y, Mohri Y, Tonouchi H, Suematsu M, Taguchi Y, Adachi Y, Kusunoki M (2004) Successful treatment of refractory hepatic lymphorrhea after gastrectomy for early gastric cancer, using surgical ligation and subsequent OK-432 (picibanil) sclerotherapy. Gastric Cancer 7:117–121. https://doi.org/10.1007/s10120-004-0276-5CrossRefPubMed

13.

Takeno A, Tamura S, Miki H, Tanigawa N, Taniguchi H, Nakahira S, Suzuki R, Nakata K, Takeda Y, Kato T (2014) Chyluria after ligation of the thoracic duct: a rare complication after thoracoscopic-assisted esophagectomy for esophageal cancer. Surg Today 44:757–760. https://doi.org/10.1007/s00595-012-0443-yCrossRefPubMed

14.

McGrath EE, Blades Z, Anderson PB (2010) Chylothorax: aetiology, diagnosis and therapeutic options. Respir Med 104:1–8. https://doi.org/10.1016/j.rmed.2009.08.010CrossRefPubMed

15.

Cerfolio RJ, Allen MS, Deschamps C, Trastek VF, Pairolero PC (1996) Postoperative chylothorax. J Thorac Cardiovasc Surg 112:1361–1365; discussion 1365–6. https://doi.org/10.1016/S0022-5223(96)70152-6CrossRefPubMed

16.

Reisenauer JS, Puig CA, Reisenauer CJ, Allen MS, Bendel E, Cassivi SD, Nichols FC, Shen RK, Wigle DA, Blackmon SH (2018) Treatment of postsurgical chylothorax. Ann Thorac Surg 105:254–262. https://doi.org/10.1016/j.athoracsur.2017.07.021CrossRefPubMed

17.

Tamura T, Kubo N, Yamamoto A, Sakurai K, Toyokawa T, Tanaka H, Muguruma K, Yashiro M, Maeda K, Hirakawa K, Ohira M (2017) Cervical chylous leakage following esophagectomy that was successfully treated by intranodal Lipiodol lymphangiography: a case report. BMC Surg 17:20. https://doi.org/10.1186/s12893-017-0218-xCrossRefPubMedPubMedCentral

18.

Kumar S, Kumar A, Pawar DK (2004) Thoracoscopic management of thoracic duct injury: is there a place for conservatism? J Postgrad Med 50:57–59PubMed

19.

Meyer CD, McLeod IK, Gallagher DJ (2016) Conservative management of an intraoperative chyle leak: a case report and literature review. Mil Med 181:e1180–e1184. https://doi.org/10.7205/MILMED-D-15-00240CrossRefPubMed

20.

Singh H, Pandit N, Krishnamurthy G, Gupta R, Verma GR, Singh R (2019) Management of chylous ascites following pancreaticobiliary surgery. JGH Open 3:425–428. https://doi.org/10.1002/jgh3.12179CrossRefPubMedPubMedCentral

21.

Rammal A, Zawawi F, Varshney R, Hier MP, Payne RJ, Mlynarek AM (2014) Chyle leak: a rare complication post-hemithyroidectomy. Case report and review of literature. Otolaryngol Pol 68:204–207. https://doi.org/10.1016/j.otpol.2014.03.003CrossRefPubMed

22.

Tabchouri N, Frampas E, Marques F, Blanchard C, Jirka A, Regenet N (2017) Chylous ascites management after pancreatic surgery. World J Surg 41:1054–1060. https://doi.org/10.1007/s00268-016-3772-yCrossRefPubMed

23.

Yannes M, Shin D, McCluskey K, Varma R, Santos E (2017) Comparative analysis of intranodal lymphangiography with percutaneous intervention for postsurgical chylous effusions. J Vasc Interv Radiol 28:704–711. https://doi.org/10.1016/j.jvir.2016.12.1209CrossRefPubMed

24.

Sommer CM, Pieper CC, Itkin M, Nadolski GJ, Hur S, Kim J, Maleux G, Kauczor HU, Richter GM (2020) Conventional lymphangiography (CL) in the management of postoperative lymphatic leakage (PLL): a systematic review. Rofo 192:1025–1035. https://doi.org/10.1055/a-1131-7889CrossRefPubMed

25.

Hur S, Shin JH, Lee IJ, Min SK, Min SI, Ahn S, Kim J, Kim SY, Kim M, Lee M, Kim HC, Jae HJ, Chung JW, Kim HB (2016) Early experience in the management of postoperative lymphatic leakage using Lipiodol lymphangiography and adjunctive glue embolization. J Vasc Interv Radiol 27:1177–1186 e1. https://doi.org/10.1016/j.jvir.2016.05.011CrossRefPubMed

26.

Baek Y, Won JH, Kong TW, Paek J, Chang SJ, Ryu HS, Kim J (2016) Lymphatic leak occurring after surgical lymph node dissection: a preliminary study assessing the feasibility and outcome of lymphatic embolization. Cardiovasc Interv Radiol 39:1728–1735. https://doi.org/10.1007/s00270-016-1435-xCrossRef

27.

Glatz T, Marjanovic G, Hoeppner J (2018) Prevention and surgical therapy of chylothorax. Zentralbl Chir 143:278–283. https://doi.org/10.1055/a-0608-5082CrossRefPubMed

28.

Talwar A, Lee HJ (2008) A contemporary review of chylothorax. Indian J Chest Allied Sci 50:343–351

29.

Maldonado F, Cartin-Ceba R, Hawkins FJ, Ryu JH (2010) Medical and surgical management of chylothorax and associated outcomes. Am J Med Sci 339:314–318. https://doi.org/10.1097/MAJ.0b013e3181cdcd6cCrossRefPubMed

30.

Paul S, Altorki NK, Port JL, Stiles B, Lee P (2009) Surgical management of chylothorax. Thorac Cardiovasc Surg 57:226–228. https://doi.org/10.1055/s-0029-1185457CrossRefPubMed

31.

Guevara CJ, Rialon KL, Ramaswamy RS, Kim SK, Darcy MD (2016) US-guided, direct puncture retrograde thoracic duct access, lymphangiography, and embolization: feasibility and efficacy. J Vasc Interv Radiol 27:1890–1896. https://doi.org/10.1016/j.jvir.2016.06.030CrossRefPubMed

32.

Schild HH, Naehle CP, Wilhelm KE, Kuhl C, Thomas D, Meyer C, Textor J, Strunk H, Willinek W, Pieper C (2015) Lymphatic interventions for treatment of chylothorax. Rofo 187:584–588. https://doi.org/10.1055/s-0034-1399438CrossRefPubMed

33.

Schild HH, Pieper C (2019) Chylothorax: current therapeutic options. Zentralbl Chir 144:S24–S30. https://doi.org/10.1055/a-0831-2649CrossRefPubMed

34.

Sommer CM, Goerig C, Richter GM (2018) Intractable postoperative lymphatic fistula with impaired wound healing. Dtsch Arztebl Int 115:376. https://doi.org/10.3238/arztebl.2018.0376CrossRefPubMed

35.

Pan F, Loos M, Do TD, Richter GM, Kauczor HU, Hackert T, Sommer CM (2020) The roles of iodized oil-based lymphangiography and post-lymphangiographic computed tomography for specific lymphatic intervention planning in patients with postoperative lymphatic fistula: a literature review and case series. CVIR Endovasc 3:79. https://doi.org/10.1186/s42155-020-00146-xCrossRefPubMedPubMedCentral

36.

Nadolski GJ, Itkin M (2012) Feasibility of ultrasound-guided intranodal lymphangiogram for thoracic duct embolization. J Vasc Interv Radiol 23:613–616. https://doi.org/10.1016/j.jvir.2012.01.078CrossRefPubMed

37.

Itkin M, Rabinowitz D, Hur S (2020) Liver lymphatic imaging and interventions: resurrection of the forgotten knowledge. Semin Interv Radiol 37:318–323. https://doi.org/10.1055/s-0040-1713638CrossRef

38.

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700. https://doi.org/10.1136/bmj.b2700CrossRefPubMedPubMedCentral

39.

Boffa DJ, Sands MJ, Rice TW, Murthy SC, Mason DP, Geisinger MA, Blackstone EH (2008) A critical evaluation of a percutaneous diagnostic and treatment strategy for chylothorax after thoracic surgery. Eur J Cardiothorac Surg 33:435–439. https://doi.org/10.1016/j.ejcts.2007.11.028CrossRefPubMed

40.

Kong TW, Chang SJ, Kim J, Paek J, Kim SH, Won JH, Ryu HS (2016) Risk factor analysis for massive lymphatic ascites after laparoscopic retroperitonal lymphadenectomy in gynecologic cancers and treatment using intranodal lymphangiography with glue embolization. J Gynecol Oncol 27:e44. https://doi.org/10.3802/jgo.2016.27.e44CrossRefPubMedPubMedCentral

41.

Majdalany BS, Khayat M, Downing T, Killoran TP, el-Haddad G, Khaja MS, Saad WA (2018) Lymphatic interventions for isolated, iatrogenic chylous ascites: a multi-institution experience. Eur J Radiol 109:41–47. https://doi.org/10.1016/j.ejrad.2018.10.019CrossRefPubMed

42.

Kim PH, Tsauo J, Shin JH (2020) Lymphangiography with or without embolization for the treatment of postoperative chylous ascites. Ann Vasc Surg 68:351–360. https://doi.org/10.1016/j.avsg.2020.04.063CrossRefPubMed

43.

Donlon NE, Nugent TS, Power R, Butt W, Kamaludin A, Dolan S, Guiney M, Mc Eniff N, Ravi N, Reynolds JV (2020) Embolization or disruption of thoracic duct and cisterna chyli leaks post oesophageal cancer surgery should be first line management for ECCG-defined type III chyle fistulae. Ir J Med Sci. https://doi.org/10.1007/s11845-020-02396-z

44.

van Goor AT, Kroger R, Klomp HM et al (2007) Introduction of lymphangiography and percutaneous embolization of the thoracic duct in a stepwise approach to the management of chylous fistulas. Head Neck 29:1017–1023. https://doi.org/10.1002/hed.20624CrossRefPubMed

45.

Patel N, Lewandowski RJ, Bove M, Nemcek AA Jr, Salem R (2008) Thoracic duct embolization: a new treatment for massive leak after neck dissection. Laryngoscope 118:680–683. https://doi.org/10.1097/MLG.0b013e31816067b8CrossRefPubMed

46.

Pieper CC, Schild HH (2015) Direct cervical puncture for retrograde thoracic duct embolization in a postoperative cervical lymphatic fistula. J Vasc Interv Radiol 26:1405–1408. https://doi.org/10.1016/j.jvir.2015.05.003CrossRefPubMed

47.

Chen E, Itkin M (2011) Thoracic duct embolization for chylous leaks. Semin Interv Radiol 28:63–74. https://doi.org/10.1055/s-0031-1273941CrossRef

48.

Savla JJ, Itkin M, Rossano JW, Dori Y (2017) Post-operative chylothorax in patients with congenital heart disease. J Am Coll Cardiol 69:2410–2422. https://doi.org/10.1016/j.jacc.2017.03.021CrossRefPubMed

49.

Kariya S, Nakatani M, Yoshida R, Ueno Y, Komemushi A, Tanigawa N (2017) Embolization for thoracic duct collateral leakage in high-output chylothorax after thoracic surgery. Cardiovasc Interv Radiol 40:55–60. https://doi.org/10.1007/s00270-016-1472-5CrossRef

50.

Syed LH, Georgiades CS, Hart VL (2007) Lymphangiography: a case study. Semin Interv Radiol 24:106–110. https://doi.org/10.1055/s-2007-971180CrossRef

51.

Jayasinghe SA, Srinivasa RN, Hage AN, Gemmete JJ, Majdalany BS, Chick JFB (2018) Thoracic duct embolization: analysis of practice patterns. Ann Vasc Surg 52:168–175. https://doi.org/10.1016/j.avsg.2018.03.016CrossRefPubMed

52.

Mittleider D, Dykes TA, Cicuto KP, Amberson SM, Leusner CR (2008) Retrograde cannulation of the thoracic duct and embolization of the cisterna chyli in the treatment of chylous ascites. J Vasc Interv Radiol 19:285–290. https://doi.org/10.1016/j.jvir.2007.10.025CrossRefPubMed

53.

Repko BM, Scorza LB, Mahraj RP (2009) Recurrent chylothorax after neck surgery: percutaneous thoracic duct embolization as primary treatment. Otolaryngol Head Neck Surg 141:426–427. https://doi.org/10.1016/j.otohns.2009.02.017CrossRefPubMed

54.

Choo JC, Foley PT, Lyon SM (2009) Percutaneous management of high-output chylothorax: case reviews. Cardiovasc Interv Radiol 32:828–832. https://doi.org/10.1007/s00270-009-9545-3CrossRef

55.

Snow AL, Uller W, Kim HB, Alomari AI (2014) Percutaneous embolization of a chylous leak from thoracic duct injury in a child. Cardiovasc Interv Radiol 37:1111–1113. https://doi.org/10.1007/s00270-013-0822-9CrossRef

56.

Parvinian A, Mohan GC, Gaba RC, Saldanha DF, Knuttinen MG, Bui JT, Minocha J (2014) Ultrasound-guided intranodal lymphangiography followed by thoracic duct embolization for treatment of postoperative bilateral chylothorax. Head Neck 36:E21–E24. https://doi.org/10.1002/hed.23425CrossRefPubMed

57.

Kaschner GM, Strunk H (2014) Transnodal ultrasound-guided lymphangiography for thoracic duct embolization in chylothorax. Dtsch Med Wochenschr 139:2231–2236. https://doi.org/10.1055/s-0034-1387288CrossRefPubMed

58.

Marthaller KJ, Johnson SP, Pride RM, Ratzer ER, Hollis HW Jr (2015) Percutaneous embolization of thoracic duct injury post-esophagectomy should be considered initial treatment for chylothorax before proceeding with open re-exploration. Am J Surg 209:235–239. https://doi.org/10.1016/j.amjsurg.2014.05.031CrossRefPubMed

59.

Ebada AH, Almazedi B, VanderWal R, Muchantef K, Boucher LM (2015) Retroperitoneal intranodal contrast agent injection for lymphangiographic imaging of the thoracic duct in view of percutaneous intervention. J Vasc Interv Radiol 26:1403–1405. https://doi.org/10.1016/j.jvir.2015.03.026CrossRefPubMed

60.

Atie M, Dunn G, Falk GL (2016) Chlyous leak after radical oesophagectomy: thoracic duct lymphangiography and embolisation (TDE)-a case report. Int J Surg Case Rep 23:12–16. https://doi.org/10.1016/j.ijscr.2016.04.002CrossRefPubMedPubMedCentral

61.

Majdalany BS, Sanogo ML, Pabon-Ramos WM, Wilson KA, Goswami AK, Kokabi N, Khaja MS (2020) Complications during lymphangiography and lymphatic interventions. Semin Interv Radiol 37:309–317. https://doi.org/10.1055/s-0040-1713448CrossRef

62.

Schild HH, Pieper CC (2020) Where have all the punctures gone? An analysis of thoracic duct embolizations. J Vasc Interv Radiol JVIR 31:74–79. https://doi.org/10.1016/j.jvir.2019.09.012CrossRefPubMed

63.

Hur S (2020) Facing the truth: penetration of vital organs during thoracic duct embolization. J Vasc Interv Radiol JVIR 31:80–81. https://doi.org/10.1016/j.jvir.2019.10.004CrossRefPubMed

64.

Laslett D, Trerotola SO, Itkin M (2012) Delayed complications following technically successful thoracic duct embolization. J Vasc Interv Radiol 23:76–79. https://doi.org/10.1016/j.jvir.2011.10.008CrossRefPubMed

65.

Pamarthi V, Stecker MS, Schenker MP, Baum RA, Killoran TP, Suzuki Han A, O’Horo SK, Rabkin DJ, Fan CM (2014) Thoracic duct embolization and disruption for treatment of chylous effusions: experience with 105 patients. J Vasc Interv Radiol 25:1398–1404. https://doi.org/10.1016/j.jvir.2014.03.027CrossRefPubMed

66.

Litherland B, Given M, Lyon S (2008) Percutaneous radiological management of high-output chylothorax with CT-guided needle disruption. J Med Imaging Radiat Oncol 52:164–167. https://doi.org/10.1111/j.1440-1673.2008.01935.xCrossRefPubMed

67.

Kwon LM, Hur S, Jeong CW, Jae HJ, Chung JW (2020) Glue embolization of lymphopseudoaneurysm for chylous ascites after retroperitoneal surgery. Korean J Radiol. 21. https://doi.org/10.3348/kjr.2020.0056

68.

Ierardi AM, Pappalardo V, Liu X et al (2016) Usefulness of CBCT and guidance software for percutaneous embolization of a lymphatic leakage after thyroidectomy for cancer. Gland Surg 5:633–638. https://doi.org/10.21037/gs.2016.12.13CrossRefPubMedPubMedCentral

69.

Dinc H, Oguz S, Sari A (2015) A novel technique in the treatment of retroperitoneal lymphatic leakage: direct percutaneous embolization through the leakage pouch. Diagn Interv Radiol 21:419–422. https://doi.org/10.5152/dir.2015.15027CrossRefPubMedPubMedCentral

70.

Chick JF, Reddy SN, Nadolski GJ et al (2016) Single-session endolymphatic glue embolization of lymphocele after heart transplantation. J Vasc Interv Radiol 27:929–930. https://doi.org/10.1016/j.jvir.2016.02.023CrossRefPubMed

71.

Itou C, Koizumi J, Myojin K, Yamashita T, Mori N, Imai Y (2013) A case of refractory chylous ascites after nephrectomy successfully treated with percutaneous obliteration using adhesive glue. Jpn J Radiol 31:71–74. https://doi.org/10.1007/s11604-012-0146-8CrossRefPubMed

72.

Smolock AR, Nadolski G, Itkin M (2018) Intranodal glue embolization for the management of postsurgical groin lymphocele and lymphorrhea. J Vasc Interv Radiol 29:1462–1465. https://doi.org/10.1016/j.jvir.2018.04.020CrossRefPubMed

73.

Hirata M, Shimizu A, Abe S, Ichinose A, Sugiyama A, Tanino Y, Watanabe S, Nakano R, Kato Y, Miyahara T, Sumi Y, Nakano H (2017) CT-guided intranodal lymphangiography for postoperative chylous ascites. Cardiovasc Interv Radiol 40:1281–1284. https://doi.org/10.1007/s00270-017-1644-yCrossRef

74.

Kuetting D, Schild HH, Pieper CC (2019) In vitro evaluation of the polymerization properties of N-butyl cyanoacrylate/iodized oil mixtures for lymphatic interventions. J Vasc Interv Radiol 30:110–117. https://doi.org/10.1016/j.jvir.2018.07.028CrossRefPubMed

75.

Baek Y, Won JH, Chang SJ, Ryu HS, Song SY, Yim B, Kim J (2016) Lymphatic embolization for the treatment of pelvic lymphoceles: preliminary experience in five patients. J Vasc Interv Radiol 27:1170–1176. https://doi.org/10.1016/j.jvir.2016.04.011CrossRefPubMed

76.

Soga S, Suyama Y, Shinmoto H (2020) Balloon-occluded retrograde glue embolization for intractable lymphorrhea from bilateral iliac lymphatics following surgery for rectal cancer. Radiol Case Rep 15:371–374. https://doi.org/10.1016/j.radcr.2020.01.017CrossRefPubMedPubMedCentral

77.

Kariya S, Nakatani M, Ueno Y, Yoshida A, Ono Y, Maruyama T, Komemushi A, Tanigawa N (2018) Transvenous retrograde thoracic ductography: initial experience with 13 consecutive cases. Cardiovasc Interv Radiol 41:406–414. https://doi.org/10.1007/s00270-017-1814-yCrossRef

78.

Chick JF, VanBelkum A, Yu V et al (2017) Balloon-occluded retrograde abdominal lymphangiography and embolization for opacification and treatment of abdominal chylous leakage. J Vasc Interv Radiol 28:616–618. https://doi.org/10.1016/j.jvir.2016.11.044CrossRefPubMed

79.

Rott G, Boecker F (2020) High-output chyloperitoneum following laparoscopic Nissen fundoplication treated with retrograde transvenous thoracic duct embolization. CVIR Endovasc 3:20. https://doi.org/10.1186/s42155-020-00110-9CrossRefPubMedPubMedCentral

80.

Bundy JJ, Chick JF, Jiao A, Cline MR, Srinivasa RN, Khayat M, Gnannt R, Johnson EJ, Gemmete JJ, Monroe EJ, Srinivasa RN (2019) Percutaneous fluoroscopically-guided transcervical retrograde access facilitates successful thoracic duct embolization after failed antegrade transabdominal access. Lymphology 52:52–60PubMed

81.

Ching KC, Santos E, McCluskey K, Jeyabalan G (2014) CT-guided injection of N-butyl cyanoacrylate glue for treatment of chylous leak after aorto-mesenteric bypass. Cardiovasc Interv Radiol 37:1103–1106. https://doi.org/10.1007/s00270-013-0811-zCrossRef

82.

Pan F, Loos M, Do TD, Richter GM, Kauczor HU, Hackert T, Sommer CM (2020) Percutaneous afferent lymphatic vessel sclerotherapy for postoperative lymphatic leakage after previous ineffective therapeutic transpedal lymphangiography. Eur Radiol Exp 4:60. https://doi.org/10.1186/s41747-020-00188-9CrossRefPubMedPubMedCentral

83.

Bartoli M, Baiocchi GL, Portolani N, Giulini SM (2015) Refractory hepatic lymphorrhea after total pancreatectomy. Case report and literature review of this uncommon complication. Int J Surg Case Rep 16:134–136. https://doi.org/10.1016/j.ijscr.2015.09.023CrossRefPubMedPubMedCentral

84.

Inoue Y, Hayashi M, Hirokawa F, Takeshita A, Tanigawa N (2011) Peritoneovenous shunt for intractable ascites due to hepatic lymphorrhea after hepatectomy. World J Gastrointest Surg 3:16–20. https://doi.org/10.4240/wjgs.v3.i1.16CrossRefPubMedPubMedCentral

85.

Nguyen NC, Inoue M, Le TL et al (2020) Intrahepatic lymphatic channel sclerotic embolization for treatment of postoperative lymphatic ascites: a report of 3 cases. Radiol Case Rep 15:2353–2357. https://doi.org/10.1016/j.radcr.2020.09.009CrossRefPubMedPubMedCentral

86.

Akhan O, Cekirge S, Ozmen M, Besim A (1992) Percutaneous transcatheter ethanol sclerotherapy of postoperative pelvic lymphoceles. Cardiovasc Interv Radiol 15:224–227. https://doi.org/10.1007/BF02733927CrossRef

87.

Akhan O, Karcaaltincaba M, Ozmen MN, Akinci D, Karcaaltincaba D, Ayhan A (2007) Percutaneous transcatheter ethanol sclerotherapy and catheter drainage of postoperative pelvic lymphoceles. Cardiovasc Interv Radiol 30:237–240. https://doi.org/10.1007/s00270-006-0180-yCrossRef

88.

Belczak SQ, Lima GBF, Aguilar KC et al (2019) Polidocanol echosclerotherapy treatment for lymphocele: case report and review. J Vasc Bras 19:e20190112. https://doi.org/10.1590/1677-5449.190112CrossRefPubMedPubMedCentral

89.

Knipping S, Goetze G, Neumann K, Bloching M (2007) Sclerotherapy of cervical cysts with picibanil (OK-432). Eur Arch Otorhinolaryngol 264:423–427. https://doi.org/10.1007/s00405-006-0201-0CrossRefPubMed

90.

Seelig MH, Klingler PJ, Oldenburg WA (1998) Treatment of a postoperative cervical chylous lymphocele by percutaneous sclerosing with povidone-iodine. J Vasc Surg 27:1148–1151. https://doi.org/10.1016/s0741-5214(98)70017-5CrossRefPubMed

91.

Gander R, Asensio M, Royo GF, Molino JA, Vilalta R, Coma A, Perez M, Ariceta G (2017) Treatment of post-transplant lymphocele in children. Urology 103:218–223. https://doi.org/10.1016/j.urology.2016.12.039CrossRefPubMed

92.

Zuckerman DA, Yeager TD (1997) Percutaneous ethanol sclerotherapy of postoperative lymphoceles. AJR Am J Roentgenol 169:433–437. https://doi.org/10.2214/ajr.169.2.9242748CrossRefPubMed

93.

Fernandes AS, Costa A, Mota R, Paiva V (2014) Bleomycin sclerotherapy for severe symptomatic and persistent pelvic lymphocele. Case Rep Obstet Gynecol 2014:624803–624808. https://doi.org/10.1155/2014/624803CrossRefPubMedPubMedCentral

94.

Cohan RH, Saeed M, Schwab SJ, Perlmutt LM, Reed Dunnick N (1988) Povidone-iodine sclerosis of pelvic lymphoceles: a prospective study. Urol Radiol 10:203–206. https://doi.org/10.1007/BF02926570CrossRefPubMed

95.

Mahrer A, Ramchandani P, Trerotola SO, Shlansky-Goldberg RD, Itkin M (2010) Sclerotherapy in the management of postoperative lymphocele. J Vasc Interv Radiol 21:1050–1053. https://doi.org/10.1016/j.jvir.2010.03.014CrossRefPubMed

Title: Radiological management of postoperative lymphorrhea
Authors: C. M. Sommer
C. C. Pieper
F. Offensperger
F. Pan
H. J. Killguss
J. Köninger
M. Loos
T. Hackert
M. Wortmann
T. D. Do
G. Maleux
G. M. Richter
H. U. Kauczor
J. Kim
S. Hur
Publication date: 01-06-2021
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 4/2021
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-021-02094-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Radiological management of postoperative lymphorrhea

Abstract

Purpose

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Method

Results

Conclusion

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