Lymphangiography: Forgotten Tool or Rising Star in the Diagnosis and Therapy of Postoperative Lymphatic Vessel Leakage

Abstract

Since the advent of computed tomography, numbers and expertise in Lymphangiography (LAG) have markedly dropped. The intention of our study was to demonstrate the persisting diagnostic and therapeutic impact of LAG on the postoperative patient with known or suspected lymphatic vessel leakage. Between May 1, 1999, and April 30, 2006, we investigated pedal lipiodol-LAGs (18 monopedal, 2 bipedal) on 22 patients (16 male, 6 female) with known or suspected postoperative chylothorax, chylaskos, lymphocele, or lymphatic fistula. Ages varied from 26 to 81 years. The spectrum of operative procedures was broad: 6 thoracic, 5 abdominal, and 11 peripheral operations were performed. In 20 patients who underwent mono- or bipedal LAG for lymphatic vessel injury, we were able to demonstrate the specific site of leakage in 15 cases (75%) and found signs of extravasation in 5 patients (25%). Furthermore, in 11 patients (55%) we were able to avoid surgery because of closure of the leak after LAG. As the conservative therapeutic approach usually takes 2-3 weeks to reveal its therapeutic effects, 73.3% (11/15) of the patients who were not reoperated before this hallmark was passed did not need any further operation. Our study clearly demonstrates that even in the decades of modern cross-sectional imaging, classic LAG is a powerful and highly reliable tool to visualize and even assist occlusion of the postoperatively damaged lymphatic vessel and may thereby avoid the need for reoperation.

Treatment options for chylous ascites after major abdominal surgery: a systematic review

“…In this study with overall 47 patients with chylous fistula, patients with contained chyle leaks represented the majority (n=34, 72.9%). These required total parenteral nutrition less frequently (44.1% vs. 92.3%), and had a shorter time to resolution (13 vs. 36 days) than those with diffuse chylous ascites (n=13)(15).The therapeutic use of bipedal lymphangiography with lipiodol has been described with occlusion rates from 35% to 70% (30,31,33) in patients with chylous ascites refractory to conservative treatment. A study by Alejandre-Lafont et al (n=43) demonstrated occlusion rates of 70% when the daily volume of chyle leakage was less than 500 ml (30).…”

Direct lymphangiography as treatment option of lymphatic leakage: Indications, outcomes and role in patient's management

“…Lymphography is helpful to visualize the anatomy of lymphatic vessels of the treatment-relevant region and the leakage site for preoperative planning of fistula occlusion [10,11]. Furthermore, lymphography itself is an effective, minimally invasive method not only for the detection but also for treatment of lymphatic leakage [10,12]. Recent studies show that magnetic resonance (MR) lymphography is a promising approach to identify specific features of lymphatic vessel leakage, but MR lymphography as a treatment option of lymphatic leakage cannot be possible [13][14][15].…”

“…In a study by Kos et al [12], 22 patients underwent lymphography. 73.3% of the reported patients had an occlusion of the postoperatively damaged lymphatic vessel and did not undergo surgery after lymphography.…”

Direct intranodal lymphangiography for recurrent chylous ascites following liver-kidney transplantation

“…[1][2][3] In this report, we describe a case in which direct intranodal LAG was used as a definitive treatment for persistent chylous ascites after liver-kidney transplantation.…”

“…3 This procedure has been described for diagnosing and treating chylous ascites after various thoracic and intra-abdominal procedures. Kos et al 1 reported 22 patients with lymph leaks who underwent Lipiodol LAG after surgical intervention. They reported the identification of the leak in 75% of the patients, and 55% demonstrated leak closure.…”