Retrograde transvenous selective lymphatic duct embolization in post donor nephrectomy chylous ascites

Kalia, Shekhar; Narkhede, Amey; Yadav, Ajit Kumar; Bhalla, Anil Kumar; Gupta, Arun

doi:10.1007/s13730-021-00618-6

Cited by 6 publications

(5 citation statements)

References 16 publications

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“…26 Retrograde lymphangiography has been described in several reports and is often used when antegrade identification of lymphatic leakage is unsuccessful. 28,31–35 Lymphostasis may also be achieved by percutaneously accessing the lymphopseudoaneurysm, then sealing with endovascular coils and glue mixture. 27…”

Section: Resultsmentioning

confidence: 99%

Contemporary Management of Chylous Ascites after Retroperitoneal Surgery: Development of an Evidence-Based Treatment Algorithm

et al. 2022

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Purpose:Chylous ascites (CA) is an uncommon complication that occurs from traumatic disruption of lymphatic channels after retroperitoneal surgery. The purpose of this study was to generate an evidence-based management strategy for CA by reviewing the current literature and available treatment modalities.Materials and Methods:A MEDLINE® literature review was performed for “chylous ascites.” Individual patient data were extracted from case series and reports to create an efficacy analysis. Treatment modality, drain output, time to escalation of care and time to resolution were recorded. The efficacy analysis was utilized to generate a data-driven treatment algorithm.Results:The literature review yielded 1,953 articles, from which 146 studies contributed data for 523 patients. The efficacy analysis included 245 patients, 168 (69%) of whom were managed successfully with conservative management (CM), at a median time to resolution of 11 days. Forty-eight patients underwent lymphangiography±embolization after CM, with a success rate of 85%. Thirty-one (12%) patients underwent surgical exploration. When treating CA, the patients who underwent stepwise management with CM followed by lymphangiography if CM failed experienced a resolution rate of 96.7%. An evidence-based treatment algorithm was created to guide treatment selection and duration of therapy before escalating to additional forms of therapy.Conclusions:In this report, we describe the largest conglomeration of iatrogenic CA cases from a literature review (523 cases) and efficacy analysis (245 cases), and created the first evidence-based treatment algorithm for this condition. Treatment success is substantial when using a stepwise combination of CM followed by lymphangiography±embolization.

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Section: Resultsmentioning

confidence: 99%

Contemporary Management of Chylous Ascites after Retroperitoneal Surgery: Development of an Evidence-Based Treatment Algorithm

et al. 2022

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“…TDE holds an advantage over surgical procedures in that the surgeon can visually assess the anatomy of the lymphatic system and leakage site [8]. However, clinical success is primarily dependent on technical success of lymphatic cannulation, and some approaches require a high level of expertise which is achieved following a long learning curve [7,10]. Technical success rates reported for TDE fall within 47-90% [7].…”

Section: Discussionmentioning

confidence: 99%

Delayed Chylothorax Following Blunt Chest Trauma Treated with Repeated Lymphangiography: A Case Presentation

et al. 2023

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Chylothorax is mostly iatrogenic, with blunt chest trauma being a rare cause. Treatment depends on the volume of drainage. Specifically, conservative treatment, such as total parenteral nutrition and pleural drainage, is performed in cases of low daily output (< 500 mL/day). Patients with persistent chylothorax despite medical treatment or with high daily output (> 1-1.5 L/day) are candidates for surgical or radiological intervention. We present a case of delayed-onset chylothorax after blunt trauma caused by thoracic spine fractures, in which persistent chylothorax was successfully managed with repeated lymphangiography with lipiodol when other treatment modalities failed. The case is peculiar in that the chylothorax occurred 40 days after the initial traumatic event and was treated with lipiodol injection, despite maintaining moderate to high daily output.

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“…This variant may lead to damage to the right LLT during LDN. Chyle leak after LDN is a rare complication [5,6,9,10]. Because of its location immediately right to the abdominal aorta, the cisterna chyli and its branches can be damaged during dissection of the kidney and renal vessels.…”

Section: Discussionmentioning

confidence: 99%

“…For this reason, lymphatic fistula complications are more common after right donor nephrectomy than after left nephrectomy. However, most reports of lymphatic leakage after donor nephrectomy occurred on the left instead of the right side [ 4 - 6 , 9 , 10 , 13 ]. An explanation for this could be that donor nephrectomy is likely to be performed more often on the left side than on the right side.…”

Section: Discussionmentioning

confidence: 99%

“…To date, no guideline exists for treating chyle leak [ 4 , 5 , 7 , 8 ]. Most reported cases were successfully treated with conservative therapy, and only a few required radiographic or surgical intervention [ 4 - 7 , 9 - 11 ]. We describe a case of a chyle leak after right transperitoneal LDN, in which conservative treatment failed.…”

Section: Introductionmentioning

confidence: 99%

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Right lumbar lymph trunk injury after right laparoscopic donor nephrectomy: a case report

Dung

Vũ

et al. 2023

Korean J Transplant

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Laparoscopic donor nephrectomy (LDN) is increasingly popular because of its advantages over open surgery. Chyle leak after donor nephrectomy is a rare but potentially lethal complication if not treated appropriately. We describe a case of a 43-year-old female patient with no remarkable history who presented a chyle leak on day 2 after right transperitoneal LDN. Since conservative treatment failed, the patient underwent magnetic resonance imaging (MRI) and intranodal lipiodol lymphangiography, which confirmed the chyle leak from the right lumbar lymph trunk into the right renal fossa. The chyle leak was percutaneously embolized twice, on postoperative day (POD) 5 and POD 10, by a mixture of N-butyl-2-cyanoacrylate and lipiodol. The drainage fluid decreased significantly after the second embolization. The subhepatic drainage tube was withdrawn on POD 14, and the patient was discharged on POD 17. MRI lymphangiography and intranodal lipiodol lymphangiography effectively identified the chyle leak point. Percutaneous embolization seems to be a safe, effective method for treating high-output chyle leaks.

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Retrograde transvenous selective lymphatic duct embolization in post donor nephrectomy chylous ascites

Cited by 6 publications

References 16 publications

Contemporary Management of Chylous Ascites after Retroperitoneal Surgery: Development of an Evidence-Based Treatment Algorithm

Contemporary Management of Chylous Ascites after Retroperitoneal Surgery: Development of an Evidence-Based Treatment Algorithm

Delayed Chylothorax Following Blunt Chest Trauma Treated with Repeated Lymphangiography: A Case Presentation

Right lumbar lymph trunk injury after right laparoscopic donor nephrectomy: a case report

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