Ultrasound-guided intranodal lipiodol lymphangiography from the groin is useful for assessment and treatment of post-esophagectomy chylothorax in three cases

Li, Jiajia; Sato, Yusuke; Motoyama, Satoru; Ishiyama, Koichi; Yamada, Kentaro; Yamamoto, Masayoshi; Wakita, Akiyuki; Kawakita, Yuta; Imai, Kazuhiro; Saito, Hajime; Hashimoto, Manabu; Minamiya, Yoshihiro

doi:10.1016/j.ijscr.2016.10.069

Cited by 10 publications

(6 citation statements)

References 9 publications

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“…The present series of four cases demonstrates the feasibility and safety of this interventional technique and confirms previous reports [6], [8], [9]. However, despite these encouraging results, the limitations of case reports must be acknowledged.…”

Section: Discussionsupporting

confidence: 88%

“…Recently, a novel technique has been described as the third treatment option for this postoperative complication, namely ultrasound (US)-guided lymphangiography with percutaneous Lipiodol embolization of the thoracic duct. Thus far, only very few publications have demonstrated the feasibility of this technique following esophagectomy, and its status with respect to the other two established treatment options remains unclear [5], [6], [7], [8], [9].…”

Section: Introductionmentioning

confidence: 99%

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Ultrasound-guided lymphangiography and interventional embolization of chylous leaks following esophagectomy

Lambertz

Chang

Hickethier

et al. 2019

Innovative Surgical Sciences

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ObjectivesPostoperative chylothorax is a serious complication after transthoracic esophagectomy, and is associated with major morbidity due to dehydration and malnutrition. For patients with high-output fistula, re-thoracotomy with ligation of the thoracic duct is the treatment of choice. Radiologic interventional management is an innovative procedure that has the potential to replace surgery in the treatment algorithm.MethodsFour patients with high-output chylous leaks following esophagectomy are presented. Ultrasound-guided lymphangiography with embolization of the thoracic duct and/or disruption of the cisterna chyli was performed to occlude the leakage site. Radiologic interventions and procedure-related outcomes are described in detail.ResultsIn all four patients, ultrasound-guided lymphangiography of the groin with injection of Lipiodol was able to detect and visualize the leakage site in the lower mediastinum. In three patients, the leak could be successfully occluded by Lipiodol embolization. In one patient, embolization failed and the disruption technique was successfully performed. No procedure-related complications were observed.ConclusionsIn case of a postoperative chylothorax, radiologic intervention is feasible and safe. The procedure is indicated for high-output chylous fistulas after esophagectomy, and should be applied early after the diagnosis of this postoperative complication.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided lymphangiography and interventional embolization of chylous leaks following esophagectomy

Lambertz

Chang

Hickethier

et al. 2019

Innovative Surgical Sciences

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“…1). These 28 articles included 5 large original case series with > 10 patients (Category I data) and 3 small original case series with 3-9 patients (Category II data) [15,[19][20][21][22][23][24][25]. The other 20 articles included were case reports and other short reports such as letters to the editor and technical notes with < 3 patients (Category III data) [14,17,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43].…”

Section: Literature Search and Selectionmentioning

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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“…Babies are at risk of sepsis as a result of loss of prothrombin, immunoglobulins, fibrinogen and lymphocytes. This complication has been on the rise in pediatric cardiac surgery, as observed in several reports [13] . Pleurodesis (PD) is one way to obtain pleural adhesion, thus obliterating chylous leaks.…”

Section: Discussionmentioning

confidence: 90%

Role of Chemical Pleurodesis in management of Resistant Chylothorax following congenital cardiac surgery

Lone¹

2019

jmscr

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Chylothorax in children is most commonly observed following the cardiac surgery for the congenital heart diseases. A number of therapeutic interventions have been used to reduce chylothorax production and promote resolution. Management involves supportive care, parenteral nutrition, octreotide infusion and if necessary chemical or surgical pleurodesis to obtain pleural adhesion, thus obliterating chylous leaks.We report herewith 3 children with refractory chylothoraces who improved significantly following pleurodesis using Povidone Iodine. Our findings suggest that this technique can be therapeutic for children with high flow chylothorax that fail to respond to conservative therapy.

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Ultrasound-guided intranodal lipiodol lymphangiography from the groin is useful for assessment and treatment of post-esophagectomy chylothorax in three cases

Cited by 10 publications

References 9 publications

Ultrasound-guided lymphangiography and interventional embolization of chylous leaks following esophagectomy

Ultrasound-guided lymphangiography and interventional embolization of chylous leaks following esophagectomy

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

Role of Chemical Pleurodesis in management of Resistant Chylothorax following congenital cardiac surgery

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