Retrograde transvenous lymphatic embolization for postoperative chylous ascites: A report of three cases and literature review

Abstract

Percutaneous transabdominal lymphangiography and embolization have been reported as useful approaches for intractable chylothorax or chylous ascites. However, they are often difficult to perform after extensive lymph node dissection because disruption of the antegrade lymphatic flow makes leaks identification difficult. When the leakage point cannot be identified or percutaneous transabdominal lymphangiography and embolization fail, a retrograde transvenous approach to the thoracic duct can be used instead. We report 3 cases of refractory chylous ascites after retroperitoneal operation or extensive lymph node dissection that was addressed by retrograde transvenous lymphatic embolization. In one case, a combination of retrograde transvenous lymphatic embolization, transcatheter sclerotherapy, and transcatheter embolization was used. These findings suggest that retrograde transvenous lymphatic embolization appears to be feasible and efficient for postoperative chylous ascites.

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

“…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…”

Lipiodol Lymphangiography and Embolization of Chylous Ascites After Pancreatoduodenectomy

“…Surgeons should be aware of the possibility of this complication. Although rare, chyle leak is a highly morbid condition and, when persistent, can lead to life-threatening complications such as malnutrition, weight loss, infection, immunodeficiency, and prolonged hospital stay 6,9,12 . Thus, early diagnosis and intervention is essential to minimize morbidity and mortality.…”

“…The main indication of TPN is when the patient does not tolerate an oral diet. In some cases, early TPN has led to a faster resolution 3,9,12 .…”

Lymphatic Interventional Radiology for Postoperative Lymphatic Leakage

“…The thoracic duct, cisterna chyli, and lumbar lymphatic duct can be approached by retrograde catheterization of the terminal portion of the thoracic duct at its orifice at the venous angle. [26][27][28] The thoracic duct orifice must first be identified at the venous angle (the junction of the thoracic duct with the vein). After obtaining venous access via either the brachial or femoral vein depending on the anatomy of the venous angle, a 4-or 5-Fr catheter is advanced to the thoracic duct orifice to perform transvenous retrograde cannulation.…”