Rofo 2019; 191(S 01): S29-S30
DOI: 10.1055/s-0037-1682086
Vortrag (Wissenschaft)
Interventionelle Radiologie
Georg Thieme Verlag KG Stuttgart · New York

Transpedal lymphangiography (TL) in the management of postoperative therapy-refractory lymphatic fistula (LF) – Mono-center experience over 25 years

C Sommer
1   Universitätsklinikum Heidelberg, Diagnostische und Interventionen Radiologie, Heidelberg
,
D Pan
2   University Hospital Heidelberg, Diagnostic and Interventional Radiology, Heidelberg
,
D Do
2   University Hospital Heidelberg, Diagnostic and Interventional Radiology, Heidelberg
,
P Richter
3   Stuttgart Clinics, Diagnostic and Interventional Radiology, Stuttgart
,
P Kauczor
2   University Hospital Heidelberg, Diagnostic and Interventional Radiology, Heidelberg
,
P Hackert
4   University Hospital Heidelberg, General, Visceral and Transplantation Surgery, Heidelberg
,
P Loos
5   University Hospital Heidelberg, General, Visceral and Transplantation Surgery
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2019 (online)

Also available at
 

Zielsetzung:

To report our mono-center experience over 25 years on transpedal lymphangiography (TL) in the management of postoperative therapy-refractory lymphatic fistula (LF)

Material und Methoden:

A systematic review of all patients undergoing TL in the management of postoperative therapy-refractory LF since 1993 (start of electronic data entry) was performed. Study goals were analyses of patient demografics as well as technical results, complications, and clinical success of TL.

Ergebnisse:

Between 03/1993 and 09/2018, 371 patients were identified. Postoperative therapy-refractory LF resulted from a variety of in part highly complex surgical procedures such as general surgery, thoraco-abdominal surgery, vascular surgery, head and neck surgery, and uro-genital surgery. Accordingly, degree and location of LF differed significantly (ranging from high-output bilateral chylothorax to low-output simple lymphopseuroaneurysm in the neck or groin). The interval between causal surgery and TL was 60 ± 169 days. Technical success rate, amount of injected iodized oil, and major and minor complication rates of/for TL were 86.8%, 10.3 ± 4.3 ml, and 0% and 0.5%, respectively. After TL, complete response, partial response and clinical failure occurred in 37.9%, 18.9% and 43.2%, respectively. Subgroups analyses identified different clinical success rates for different types of LF. In 20 patients with partial response or clinical failure, CT-guided sclerotherapy was performed as lymphatic second-line intervention 9 ± 13 days after TL. Thereby, amount of injected ethanol 95%, major and minor complication rates and complete and partial response rates were 3.5 ± 2.0 ml, 5.0% and 0%, and 50.0% and 20.0%, respectively.

Schlussfolgerungen:

TL is feasible, safe and effective in the management of postoperative therapy-refractory LF. In case of clinical failure, lymphatic second-line interventions such as CT-guided sclerotherapy are indicated to further improve clinical success.The best treatment algorithm has yet to be outlined and confirmed in prospective trials.