Lymphangiography and Lymphatic Embolization for the Treatment of Refractory Chylous Ascites

Abstract

Lymphangiography and embolization can be used to treat chylous ascites. Identification of the site of leak is associated with significantly greater rate of clinical success compared to those whose site could not be identified.

Chylous Ascites and Lymphoceles: Evaluation and Interventions

“…The published experience in the percutaneous treatment of postoperative CA is limited to case reports and retrospective series. 22,24,46 Majdalany et al recently reviewed the published experience for percutaneous treatment of traumatic CAs. They found 18 studies besides their cohort that included 96 patients with CA or CA associated with chylothorax, chylopericardium, or lymphoceles.…”

“…Studies have reported a detection rate of 55% for leakage sites in patients with CA. 22,24 This rate is lower compared with those patients with chylothorax. Anatomically, the intestinal and the hepatic lymphatic ducts that carry the chyle to join lumbar ducts or the cisterna chyli are often outside the pathway of the contrast that is injected in the groin lymph nodes.…”

“…[19][20][21] Nadolski et al reported nine patients who underwent DC-MRL in the setting of CA demonstrating lymphatic leakage in seven patients all of which had traumatic etiology. 22 Lymphangiography is an important technique for the detection and treatment of lymphatic leaks. The development of intranodal lymphangiography (INL) has simplified the access to the lymphatic system.…”

“…Anatomically, the intestinal and the hepatic lymphatic ducts that carry the chyle to join lumbar ducts or the cisterna chyli are often outside the pathway of the contrast that is injected in the groin lymph nodes. 22 To overcome this limitation of the INL, several techniques have been proposed to perform retrograde access of the TD in an attempt to identify leaks in the upper abdomen and distal intestinal lymphatics: transvenous catheterization, cervical percutaneous access (under ultrasound or fluoroscopy guidance), and snaring a wire previously inserted in the TD from an anterograde approach into the venous system. [24][25][26] Lymphangiography has a therapeutic role in patients with chylous leaks due to the embolic properties of the ethiodized oil.…”

Lymphatics, Long a Mystery—Primed to Make History

“…12,13 Successful treatments of pediatric chylothorax, chylous ascites, protein losing enteropathy, and plastic bronchitis are being increasingly described at different medical centers across the world. [14][15][16][17][18][19] These treatments involve novel approaches and utilize techniques that include retrograde transvenous lymphangiography, transcervical lymphangiography, thoracic duct stent-grafting, and balloon occlusion retrograde abdominal lymphangiography, among others. [20][21][22][23] The relationship of lymphatics with fluid balance, nutritional absorption, immunological function, endocrine organs, and spread of malignancy provides the potential to treat many more conditions.…”