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

Abstract

In the management of patients with postoperative lymphatic fistula (LF) in different locations, iodized oil-based lymphangiography (LAG) from trans-pedal or intranodal route is an established diagnostic approach with the potential to plan further interventional treatments. However, specific lymphatic interventions are indicated depending on different locations and morphologies of the LF. After a systematic literature review, four types of interventions can be considered, including direct leakage embolization/sclerotherapy (DLE/DLS), percutaneous afferent lymphatic vessel embolization (ALVE), percutaneous afferent lymphatic vessels disruption/sclerotherapy (ALVD/ALVS), and trans-afferent nodal embolization (TNE). In the iodized oil-based LAG, three potential lymphatic targets including confined leakage, definite afferent LVs, and definite closest afferent LNs should be comprehensively assessed. For optimal prospective treatment planning for LF, iodized oil-based post-lymphangiographic computed tomography (post-LAG CT) is a useful complement to the conventional iodized oil-based LAG, which can be performed easily after LAG. This review article summarized the current evidence of the specific lymphatic interventions in patients with postoperative LF and explored the potential benefits of post-LAG CT in the intervention planning from a case series.

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

“… Filling-phase CT indicated simultaneous chest CT after TL, while nodal-phase CT indicated chest CT 24 h after TL ( 20 ). TL, transpedal lymphangiography; n.a., no applicable .…”

“…In previous studies, the ethiodized oil usage in TL was mostly around 10 ml ( 5 , 8 – 11 , 18 , 20 – 22 ). But after accomplishment of injection, the ethiodized oil probably only reached pelvic or abdominal lymphatic vessels, so interventionalists always needed to monitor for more than 4 h until the ethiodized oil flowed into the thoracic duct ( 8 , 11 , 20 – 22 ).…”

“…The treatment success of TL is defined as immediate cessation or gradual reduction of lymphatic leakage after TL leading to the removal of thoracic drainage within 2 weeks without the requirement of other treatments ( 6 , 11 , 18 , 19 ). The lymphatic duct leakage is identified as definite ethiodized oil extravasation out from thoracic duct visualized in dynamic fluoroscopy, or the ectopic presence of the ethiodized oil in the pleural space observed in chest CT after TL ( 20 ).…”

“…Then, the needle was removed and the dorsal wound of the foot was sutured. The chest CT (SOMATON emotion 16, Siemens, Germany) was immediately performed (filling phase) to identify the specific lymphatic leakage site with 3-dimensional reconstruction (scan parameters: 120 kv, adaptive current, and B30f iterative reconstruction) ( 20 ). If there is no lymphatic fistula, the same chest CT examination will be re-performed 24 h later (nodal phase) for further diagnosis ( 20 ).…”

Therapeutic lymphography for persistent chyle leak after pancreatic surgery

“…Presentation of extravasation on radiography and/or CT or the visibility of methylene blue in the drain was defined as a radiological or nonradiological verification of chyle leak, respectively. 13 Experienced interventional radiologists conducted all procedures.…”