Intranodal Lymphangiography With High-Dose Ethiodized Oil Shows Efficient Results in Patients With Refractory, High-Output Postsurgical Chylothorax: A Retrospective Study

Jardinet, Thomas; Veer, Hans Van; Nafteux, Philippe; Depypere, Lieven; Coosemans, Willy; Maleux, Geert

doi:10.2214/ajr.20.23465

Cited by 14 publications

(14 citation statements)

References 12 publications

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“…It achieved a treatment success rate of 83% without any adverse event for the treatment of high-flow postoperative chylothorax, similar to our findings ( 24 ). However, we need to point out: in INL, part of the ethiodized oil was wasted because of the extravasation from the punctured lymph node, so we can't confirm how much of the ethiodized oil genuinely entered the lymphatic system ( 8 , 24 ). But in TL, the needle was fixed with suture resulting in a more reliable ethiodized oil injection without any waste, resulting in less usage of ethiodized oil than INL ( 21 ).…”

Section: Discussionsupporting

confidence: 90%

“…It explained why the treatment success rate of TL for the high-flow postoperative chylothorax reached 86% (6/7) in our cohort, which was higher than 35% in previous reports ( 5 , 10 ). Similarly, a recent report also showed that high-dose ethiodized oil (>40 ml) application in intranodal lymphangiography (INL) was feasible and safe ( 24 ). It achieved a treatment success rate of 83% without any adverse event for the treatment of high-flow postoperative chylothorax, similar to our findings ( 24 ).…”

Section: Discussionmentioning

confidence: 96%

“…Similarly, a recent report also showed that high-dose ethiodized oil (>40 ml) application in intranodal lymphangiography (INL) was feasible and safe ( 24 ). It achieved a treatment success rate of 83% without any adverse event for the treatment of high-flow postoperative chylothorax, similar to our findings ( 24 ). However, we need to point out: in INL, part of the ethiodized oil was wasted because of the extravasation from the punctured lymph node, so we can't confirm how much of the ethiodized oil genuinely entered the lymphatic system ( 8 , 24 ).…”

Section: Discussionmentioning

confidence: 96%

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Preliminary Exploration of Transpedal Lymphangiography With High-Dose Ethiodized Oil Application in the Treatment of Postoperative Chylothorax

Liu

et al. 2021

Front. Med.

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Objective: To preliminarily explore the safety and effectiveness of transpedal lymphangiography (TL) with high-dose ethiodized oil application (>20 ml) in the treatment of high-output postoperative chylothorax.Methods: From 1 July 2020 to 1 July 2021, a total of 7 patients with high-flow postoperative chylothorax (> 1,000 ml/d) were retrospectively reviewed in a single center. Clinical data, including surgery types, technical and treatment success of TL, and adverse events of TL, were collected and analyzed.Results: Seven patients (5 cases of non-small cell lung cancer; 2 cases of esophageal carcinoma) with a median age of 62 years (range: 30–70 years) occurred postoperative chylothorax after tumor resection with mediastinal lymphadenectomy. All patients received conservative treatment including total parenteral nutrition and somatostatin administration for a median of 20 days (range: 15–31 days) that failed to cure the chylothorax, so TL was performed as a salvage. Before TL, the median daily chyle output was 1,500 ml/day (range: 1,100–2,000 ml/day). The technical success rate of TL was 100% (7/7), with the median volume of ethiodized oil of 27.6 ml (range: 21.2–30.0 ml) injected in TL. Ruptured thoracic duct was identified in 5 patients (5/7, 71%) in fluoroscopy and chest CT after TL. The treatment success rate of TL was 86% (6/7). In 6 patients, the thoracic drainage was removed after a median of 7 days (range: 4–13 days) from TL performance. No adverse event of TL was reported.Conclusion: Transpedal lymphangiography with high-dose ethiodized oil application (>20 ml) is a feasible, safe, and effective modality for the treatment of high-flow (> 1,000 ml/day) postoperative chylothorax.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 96%

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Preliminary Exploration of Transpedal Lymphangiography With High-Dose Ethiodized Oil Application in the Treatment of Postoperative Chylothorax

Liu

et al. 2021

Front. Med.

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“…There are limited data on therapeutic success of LG in the treatment of lymphocele with some even showing discouraging results. In the previously mentioned study, LG therapeutic success in lymphocele cases was only 50%, but other studies have suggested that higher volumes of ethiodized oils have more therapeutic benefit (22,38).…”

Section: Lipiodol Lymphangiographymentioning

confidence: 81%

Minimally Invasive Treatment of Abdominal Lymphocele: A Review of Contemporary Options and How to Approach Them

et al. 2021

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Lymphoceles are lymphatic fluid collections resulting from lymphatic vessel disruption after surgery or trauma. They are most often described following retroperitoneal surgeries such as cystectomies, prostatectomies, renal transplants, and gynecologic surgeries. Most lymphoceles are asymptomatic and resolve spontaneously without treatment. If persistent, they can become infected or exert mass effect on adjacent structures causing pain, urinary, or lower limb edema particularly for lymphoceles in the pelvis Symptomatic lymphoceles should be treated to relieve symptoms and prevent functional compromise of vital adjacent structures. Although surgery has been traditionally accepted as the gold standard treatment, advances in imaging and interventional technology allow for less invasive, percutaneous treatment. Available minimally invasive treatment options include percutaneous aspiration, catheter drainage, sclerotherapy, and lymphangiography with lymphatic embolization. A review of these treatment options and a suggested algorithm for managing lymphoceles is presented.

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“…As a shred of additional evidence, the present study also found abnormally dilated blood vessels in the lymph node parenchyma presenting as larger empty spaces in the histopathological examination of lymph nodes after INL, suggesting the fact that lipiodol entered the blood circulation through the lymph sinuses. These findings partly explain why in inguinal iodine-based INL, there is a reported risk of ectopic embolism due to potential lymph-venous shunts (Hsu and Itkin 2016;Jardinet et al 2021). Although the lipiodol-glue embolization may lead to injury to the parenchyma around lymphatic sinuses, the damage is very mild and focal.…”

Section: To Recapitulate Key Anatomical and Histopathologicalmentioning

confidence: 90%

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

et al. 2023

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Purpose To present a preclinical in vivo approach for standardization and training of lymphangiography and lymphatic interventions using a pictorial review. Materials and methods Different lipiodol- and gadolinium-based lymphangiography and lymphatic interventions were performed in twelve (12) landrace pigs with a mean bodyweight of 34 ± 2 kg using various imaging and guiding modalities, similar to the procedures used in humans. The techniques used were explicitly introduced and illustrated. The potential applications of each technique in preclinical training were also discussed. Results By applying visual, ultrasonography, fluoroscopy, CT, cone-beam CT, and/or MRI examination or guidance, a total of eleven techniques were successfully implemented in twelve pigs. The presented techniques include inguinal postoperative lymphatic leakage (PLL) establishment, interstitial dye test, five types of lymphangiography [incl. lipiodol-based translymphatic lymphangiography (TL), lipiodol-based percutaneous intranodal lymphangiography (INL), lipiodol-based laparotomic INL, lipiodol-based interstitial lymphangiography, and interstitial magnetic resonance lymphangiography (MRL)], and four types of percutaneous interventions in the treatment of PLL [incl. thoracic duct embolization (TDE), intranodal embolization (INE), afferent lymphatic vessel sclerotherapy (ALVS), and afferent lymphatic vessel embolization (ALVE)]. Conclusion This study provides a valuable resource for inexperienced interventional radiologists to undergo the preclinical training in lymphangiography and lymphatic interventions using healthy pig models.

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Intranodal Lymphangiography With High-Dose Ethiodized Oil Shows Efficient Results in Patients With Refractory, High-Output Postsurgical Chylothorax: A Retrospective Study

Cited by 14 publications

References 12 publications

Preliminary Exploration of Transpedal Lymphangiography With High-Dose Ethiodized Oil Application in the Treatment of Postoperative Chylothorax

Preliminary Exploration of Transpedal Lymphangiography With High-Dose Ethiodized Oil Application in the Treatment of Postoperative Chylothorax

Minimally Invasive Treatment of Abdominal Lymphocele: A Review of Contemporary Options and How to Approach Them

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

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