Therapeutic Lymphangiography and CT-guided Sclerotherapy for the Treatment of Refractory Lymphatic Leakage

Kortes, Nikolas; Radeleff, Boris; Sommer, CM; Bellemann, Nadine; Ott, Katja; Richter, Goetz M.; Kauczor, Hans‐Ulrich; Stampfl, Ulrike

doi:10.1016/j.jvir.2013.10.011

Cited by 55 publications

(65 citation statements)

References 11 publications

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“…As many as 24%‐40% of patients fail conservative therapy and require more aggressive management such as paracentesis, intra‐abdominal drain placement, and even surgical exploration . Although surgical exploration and therapeutic lymphangiography is reserved for those patients that have failed initial management, these patients are still routinely managed with drain placement, dietary modifications and bowel rest postoperatively …”

Section: Discussionmentioning

confidence: 99%

“…Although therapeutic lymphangiography has been proposed as a potential intervention, these patients routinely have a drainage catheter in situ, which may explain the improvement in the chylous leak. Percutaneous drain placement may be a safer, less invasive option, and may provide faster resolution of the problem. Our findings challenge the algorithm postulated by Jairath et al who stated drains with greater than 1000 ml per day should have immediate surgical exploration .…”

Section: Discussionmentioning

confidence: 99%

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Chylous ascites following laparoscopic live donor nephrectomy: A new improved treatment paradigm

Dale

Sandoval

Ratner

2019

Clinical Transplantation

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Chylous ascites is a difficult, albeit uncommon complication of laparoscopic live donor nephrectomy (LLDN). Lymphatic leak is believed to be a result of injury to the cisterna chyli, regional lymph nodes, or other peri-aortic lymphatics intraoperatively. Recommended management with dietary modifications can result in malnutritionand immunodeficiency. We present four patients who developed chylous ascites fol-

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Chylous ascites following laparoscopic live donor nephrectomy: A new improved treatment paradigm

Dale

Sandoval

Ratner

2019

Clinical Transplantation

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“…Surgical management comprises different and at least in parts non-standardized approaches such as lymph duct ligation, shunt implantation, sclerotherapy with doxycycline or thrombin, plastic surgery, and wound vacuum therapy [6,7]. Depending on the type, degree and location of PLL, both conservative and surgical management can be challenging to perform, time-consuming and expensive as well as clinically ineffective, whereby surgery-related complication and mortality rates of up to 38 % and 25 %, respectively, have been described [1,3,4,6,[8][9][10][11][12][13]. Conventional lymphangiography (CL), a radiological examination performed under X-ray imaging after contrast material injection, has emerged as an alternative to the aforementioned treatments.…”

Section: Introductionmentioning

confidence: 99%

“…Conventional lymphangiography (CL), a radiological examination performed under X-ray imaging after contrast material injection, has emerged as an alternative to the aforementioned treatments. In different articles, CL was described as a minimally invasive diagnostic tool for determining the precise location of the PLL but more importantly there are multiple articles outlining the therapeutic effects of CL [3,4,10,[14][15][16][17]. Although CL is increasingly applied in clinical practice, the technique, safety, and efficacy have not been analyzed in a systematic review.…”

Section: Introductionmentioning

confidence: 99%

Conventional Lymphangiography (CL) in the Management of Postoperative Lymphatic Leakage (PLL): A Systematic Review

Sommer

Pieper

Itkin³

et al. 2020

Rofo

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Background Postoperative lymphatic leakage (PLL) is usually managed by conservative and/or surgical treatments but these procedures can be challenging to perform and potentially clinically ineffective. Therefore, conventional lymphangiography (CL) has emerged as an important alternative. The aim of this review is to present the available outcome data on CL in the management of PLL. Method A systematic literature search (PubMed) using the MeSH term “lymphangiography” was performed and the search was restricted to literature published between January 2007 and August 2019. Identification, screening, and assessment for eligibility and inclusion were conducted in accordance with PRISMA. Results From the initially obtained 1006 articles (identification), 28 articles with a total of 201 patients were finally included (inclusion). The methodological quality of all included articles corresponds to level 4 (Oxford Centre for Evidence-based Medicine – Levels of Evidence, March 2009). PLL occurs after oncological and non-oncological surgery in the form of chylothorax, chylous ascites, and cervical, thoracic, abdominal and peripheral lymph fistula and/or lymphocele. The technical success rate of CL is 75–100 %. Access for CL is transpedal (176 patients) or intranodal (25 patients). Lipiodol is used as the contrast material in all articles, with a maximum amount of 20 ml for transpedal CL and 30 ml for intranodal CL. The X-ray imaging modalities used for CL are fluoroscopy, radiography and/or CT. Two articles report CL-associated major complications and CL-associated morbidity and mortality. The PLL cure rate is 51–70 % for transpedal CL (time to PLL cure: 2–29 days) and 33–100 % for intranodal CL (time to PLL cure: 2–< 30 days). Bailout procedures in the case of clinically ineffective CL include a range of treatments. Conclusion CL is feasible, safe, and effective in the management of PLL. Lipiodol as the contrast material is essential in CL because the highly viscous iodinated poppy-seed oil has not only diagnostic but therapeutic effects. Guidelines and randomized controlled trials are further steps towards defining the ultimate value of CL. Key Points: Citation Format

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“…In the literature, this is called “lymphangioma circumscriptum,” which can cause lymphatic leakage predisposing patients to infections and worsened quality of life. Several treatment approaches including cryotherapy, laser, sclerotherapy, and therapeutic lymphangiography have been reported. Sirolimus, an mTOR inhibitor, has recently been introduced into the treatment of complicated vascular anomalies .…”

mentioning

confidence: 99%

Sirolimus is highly effective for lymph leakage in microcystic lymphatic malformations with skin involvement

Rößler

Geiger

Földi³

et al. 2016

Int J Dermatology

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Therapeutic Lymphangiography and CT-guided Sclerotherapy for the Treatment of Refractory Lymphatic Leakage

Cited by 55 publications

References 11 publications

Chylous ascites following laparoscopic live donor nephrectomy: A new improved treatment paradigm

Chylous ascites following laparoscopic live donor nephrectomy: A new improved treatment paradigm

Conventional Lymphangiography (CL) in the Management of Postoperative Lymphatic Leakage (PLL): A Systematic Review

Sirolimus is highly effective for lymph leakage in microcystic lymphatic malformations with skin involvement

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