Digestive Disease Interventions
DOI: 10.1055/s-0044-1786040
Review Article

Lymphatic Interventional Radiology for Postoperative Lymphatic Leakage

1   Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
2   Department of Diagnostic Ultrasound & Interventional Radiology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
,
2   Department of Diagnostic Ultrasound & Interventional Radiology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
,
1   Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
,
Satoshi Tsuchiya
3   Department of Radiology, Chiba University Hospital, Chiba, Japan
,
Masayoshi Yamamoto
4   Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
,
5   Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Aichi, Japan
› Author Affiliations

Abstract

Lymphatic leakage is a relatively rare complication following various surgical procedures. Occasionally, conservative treatments fail to control postoperative lymphatic leakage. Refractory lymphatic leakage causes severe morbidities, including malnutrition, immunodeficiency, and impaired wound healing. Lymphangiography is a useful method for identifying various types of lymphatic leakage. Recently, lipiodol lymphangiography has been popular for its potential therapeutic effects on refractory lymphatic leakage, but this technique remains underdeveloped. This review discusses lymphatic interventional radiology for postoperative lymphatic leakage.



Publication History

Received: 06 March 2024

Accepted: 19 March 2024

Article published online:
18 April 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Lv S, Wang Q, Zhao W. et al. A review of the postoperative lymphatic leakage. Oncotarget 2017; 8 (40) 69062-69075
  • 2 Sommer CM, Pieper CC, Offensperger F. et al. Radiological management of postoperative lymphorrhea. Langenbecks Arch Surg 2021; 406 (04) 945-969
  • 3 Kariya S, Yamamoto S, Nakatani M, Ono Y, Maruyama T, Tanigawa N. The role of lymphatic interventional radiology for postoperative lymphorrhea. Int J Gastrointest Interv 2022; 11 (04) 186-191
  • 4 Abe T, Kawakami J, Uemura N. et al. Therapeutic strategy for chylous leakage after esophagectomy: focusing on lymphangiography using lipiodol. Esophagus 2016; 13: 237-244
  • 5 Lee EW, Shin JH, Ko HK, Park J, Kim SH, Sung KB. Lymphangiography to treat postoperative lymphatic leakage: a technical review. Korean J Radiol 2014; 15 (06) 724-732
  • 6 Matsumoto T, Yamagami T, Kato T. et al. The effectiveness of lymphangiography as a treatment method for various chyle leakages. Br J Radiol 2009; 82 (976) 286-290
  • 7 Kawasaki R, Sugimoto K, Fujii M. et al. Therapeutic effectiveness of diagnostic lymphangiography for refractory postoperative chylothorax and chylous ascites: correlation with radiologic findings and preceding medical treatment. AJR Am J Roentgenol 2013; 201 (03) 659-666
  • 8 Kos S, Haueisen H, Lachmund U, Roeren T. Lymphangiography: forgotten tool or rising star in the diagnosis and therapy of postoperative lymphatic vessel leakage. Cardiovasc Intervent Radiol 2007; 30 (05) 968-973
  • 9 Hur S, Shin JH, Lee IJ. et al. Early experience in the management of postoperative lymphatic leakage using lipiodol lymphangiography and adjunctive glue embolization. J Vasc Interv Radiol 2016; 27 (08) 1177-1186.e1
  • 10 Itkin M, Nadolski GJ. Modern techniques of lymphangiography and interventions: current status and future development. Cardiovasc Intervent Radiol 2018; 41 (03) 366-376
  • 11 Itkin M, Kucharczuk JC, Kwak A, Trerotola SO, Kaiser LR. Nonoperative thoracic duct embolization for traumatic thoracic duct leak: experience in 109 patients. J Thorac Cardiovasc Surg 2010; 139 (03) 584-589 , discussion 589–590
  • 12 Nadolski GJ, Itkin M. Feasibility of ultrasound-guided intranodal lymphangiogram for thoracic duct embolization. J Vasc Interv Radiol 2012; 23 (05) 613-616
  • 13 Kariya S, Komemushi A, Nakatani M, Yoshida R, Kono Y, Tanigawa N. Intranodal lymphangiogram: technical aspects and findings. Cardiovasc Intervent Radiol 2014; 37 (06) 1606-1610
  • 14 Kim PH, Tsauo J, Shin JH. Lymphatic interventions for chylothorax: a systematic review and meta-analysis. J Vasc Interv Radiol 2018; 29 (02) 194-202.e4
  • 15 Inoue M, Nakatsuka S, Yashiro H. et al. Lymphatic intervention for various types of lymphorrhea: access and treatment. Radiographics 2016; 36 (07) 2199-2211
  • 16 Alejandre-Lafont E, Krompiec C, Rau WS, Krombach GA. Effectiveness of therapeutic lymphography on lymphatic leakage. Acta Radiol 2011; 52 (03) 305-311
  • 17 Majdalany BS, Khayat M, Downing T. et al. Lymphatic interventions for isolated, iatrogenic chylous ascites: a multi-institution experience. Eur J Radiol 2018; 109: 41-47
  • 18 Kortes N, Radeleff B, Sommer CM. et al. Therapeutic lymphangiography and CT-guided sclerotherapy for the treatment of refractory lymphatic leakage. J Vasc Interv Radiol 2014; 25 (01) 127-132
  • 19 Kojima M, Inoue M, Yamamoto S, Kanai T, Nakatsuka S, Nakagawa M. Successful treatment of hepatic lymphorrhea by percutaneous transhepatic lymphangiography followed by sclerotherapy using OK-432. Surg Case Rep 2019; 5 (01) 203
  • 20 Nadolski GJ, Chauhan NR, Itkin M. Lymphangiography and lymphatic embolization for the treatment of refractory chylous ascites. Cardiovasc Intervent Radiol 2018; 41 (03) 415-423
  • 21 Chu HH, Shin JH, Kim JW, Noh SY, Yang WJ, Park S. Lymphangiography and lymphatic embolization for the management of pelvic lymphocele after radical prostatectomy in prostatic cancer. Cardiovasc Intervent Radiol 2019; 42 (06) 873-879
  • 22 Cope C. Diagnosis and treatment of postoperative chyle leakage via percutaneous transabdominal catheterization of the cisterna chyli: a preliminary study. J Vasc Interv Radiol 1998; 9 (05) 727-734
  • 23 Cope C, Salem R, Kaiser LR. Management of chylothorax by percutaneous catheterization and embolization of the thoracic duct: prospective trial. J Vasc Interv Radiol 1999; 10 (09) 1248-1254
  • 24 Cope C, Kaiser LR. Management of unremitting chylothorax by percutaneous embolization and blockage of retroperitoneal lymphatic vessels in 42 patients. J Vasc Interv Radiol 2002; 13 (11) 1139-1148
  • 25 Donlon NE, Nugent TS, Power R. et al. Embolization or disruption of thoracic duct and cisterna chyli leaks post oesophageal cancer surgery should be first line management for ECCG-defined type III chyle fistulae. Ir J Med Sci 2021; 190 (03) 1111-1116
  • 26 Kariya S, Nakatani M, Ueno Y. et al. Transvenous retrograde thoracic ductography: initial experience with 13 consecutive cases. Cardiovasc Intervent Radiol 2018; 41 (03) 406-414
  • 27 Mittleider D, Dykes TA, Cicuto KP, Amberson SM, Leusner CR. Retrograde cannulation of the thoracic duct and embolization of the cisterna chyli in the treatment of chylous ascites. J Vasc Interv Radiol 2008; 19 (2, Pt 1): 285-290
  • 28 Morikawa K, Takenaga S, Hasumi J. et al. Retrograde transvenous lymphatic embolization for postoperative chylous ascites: a report of three cases and literature review. Radiol Case Rep 2020; 15 (09) 1623-1628
  • 29 Chick JF, VanBelkum A, Yu V. et al. Balloon-occluded retrograde abdominal lymphangiography and embolization for opacification and treatment of abdominal chylous leakage. J Vasc Interv Radiol 2017; 28 (04) 616-618
  • 30 Guevara CJ, Rialon KL, Ramaswamy RS, Kim SK, Darcy MD. US-guided, direct puncture retrograde thoracic duct access, lymphangiography, and embolization: feasibility and efficacy. J Vasc Interv Radiol 2016; 27 (12) 1890-1896
  • 31 Bartoli M, Baiocchi GL, Portolani N, Giulini SM. Refractory hepatic lymphorrhea after total pancreatectomy. Case report and literature review of this uncommon complication. Int J Surg Case Rep 2015; 16: 134-136
  • 32 Itkin M, Rabinowitz D, Hur S. Liver lymphatic imaging and interventions: resurrection of the forgotten knowledge. Semin Intervent Radiol 2020; 37 (03) 318-323
  • 33 Guez D, Nadolski GJ, Pukenas BA, Itkin M. Transhepatic lymphatic embolization of intractable hepatic lymphorrhea. J Vasc Interv Radiol 2014; 25 (01) 149-150
  • 34 Nguyen NC, Inoue M, Le TL. et al. Intrahepatic lymphatic channel sclerotic embolization for treatment of postoperative lymphatic ascites: a report of 3 cases. Radiol Case Rep 2020; 15 (11) 2353-2357
  • 35 Hasegawa T, Tsuboi M, Fukushima K, Yukawa T. Refractory hepatic lymphorrhea: percutaneous transhepatic lymphangiography and embolization with n-butyl-2-cyanoacrylate glue. Cardiovasc Intervent Radiol 2021; 44 (07) 1127-1130