DOI QR코드

DOI QR Code

Glue Embolization of Lymphopseudoaneurysm for Chylous Ascites after Retroperitoneal Surgery

  • Lyo Min Kwon (Department of Radiology, Seoul National University College of Medicine) ;
  • Saebeom Hur (Department of Radiology, Seoul National University College of Medicine) ;
  • Chang Wook Jeong (Department of Urology, Seoul National University College of Medicine) ;
  • Hwan Jun Jae (Department of Radiology, Seoul National University College of Medicine) ;
  • Jin Wook Chung (Department of Radiology, Seoul National University College of Medicine)
  • Received : 2020.01.23
  • Accepted : 2020.05.26
  • Published : 2021.03.01

Abstract

Objective: To assess the safety and efficacy of lymphopseudoaneurysm (LPA) glue (n-butyl cyanoacrylate [NBCA]) embolization in the management of chylous ascites after retroperitoneal surgery. Materials and Methods: A retrospective analysis from January 2014 to October 2018 was performed in six patients (4 females and 2 males; mean age, 45.3 ± 14.2 years; range, 26-61 years) who underwent LPA embolization for chylous ascites developing after retroperitoneal surgery involving the perirenal space (four donor nephrectomies, one partial nephrectomy, and one retroperitoneal lymphadenectomy). After placing a percutaneous drainage catheter into the LPA or adjacent lymphocele, embolization was performed by filling the LPA itself with a mixture of glue and Lipiodol (Guerbet). Results: Daily drainage from percutaneously placed drains exceeded 300 mL/day despite medical and surgical treatment (volume: mean, 1173 ± 1098 mL; range, 305-2800 mL). Intranodal lymphangiography was performed in four of the six patients and revealed leakage in 2 patients. Percutaneous embolization of the LPA was successful in all patients using an NBCA and Lipiodol mixture in a ratio of 1:1-1:2 (volume: mean, 4.3 ± 1.1 mL; range, 3-6 mL). Chylous ascites was resolved and the drainage catheter was removed in all patients within 4 days after the procedure (mean, 2.0 ± 1.8 days; range, 0-4 days). No procedure-related complications or recurrence of chylous ascites occurred during a mean follow-up period of 37.3 months (range, 21.1-48.4 months). Conclusion: Glue embolization of LPA has the potential to be a feasible and effective treatment method for the management of chylous ascites after retroperitoneal surgery.

Keywords

Acknowledgement

This study was supported by grant no. NRF-2018R1C1B6007875 from the Basic Science Research Program of the National Research Foundation of Korea, which is funded by the Ministry of Science and ICT.

References

  1. Weniger M, D'Haese JG, Angele MK, Kleespies A, Werner J, Hartwig W. Treatment options for chylous ascites after major abdominal surgery: a systematic review. Am J Surg 2016;211:206-213  https://doi.org/10.1016/j.amjsurg.2015.04.012
  2. Tiong HY, Goel RK, White WM, Goldfarb DA, Kaouk JH. Chylous ascites after laparoscopic donor nephrectomy. Asian J Endosc Surg 2015;8:34-39  https://doi.org/10.1111/ases.12144
  3. Hur S, Shin JH, Lee IJ, Min SK, Min SI, Ahn S, et al. Early experience in the management of postoperative lymphatic leakage using lipiodol lymphangiography and adjunctive glue embolization. J Vasc Interv Radiol 2016;27:1177-1186.e1  https://doi.org/10.1016/j.jvir.2016.05.011
  4. Itou C, Koizumi J, Myojin K, Yamashita T, Mori N, Imai Y. A case of refractory chylous ascites after nephrectomy successfully treated with percutaneous obliteration using adhesive glue. Jpn J Radiol 2013;31:71-74  https://doi.org/10.1007/s11604-012-0146-8
  5. Ching KC, Santos E, McCluskey K, Jeyabalan G. CT-guided injection of N-butyl cyanoacrylate glue for treatment of chylous leak after aorto-mesenteric bypass. Cardiovasc Intervet Radiol 2014;37:1103-1106  https://doi.org/10.1007/s00270-013-0811-z
  6. Dinc H, Og˘ uz S,, Sari A. A novel technique in the treatment of retroperitoneal lymphatic leakage: direct percutaneous embolization through the leakage pouch. Diagn Interv Radiol 2015;21:419-422  https://doi.org/10.5152/dir.2015.15027
  7. Nadolski GJ, Chauhan NR, Itkin M. Lymphangiography and lymphatic embolization for the treatment of refractory chylous ascites. Cardiovasc Intervent Radiol 2018;41:415-423  https://doi.org/10.1007/s00270-017-1856-1
  8. Majdalany BS, Khayat M, Downing T, Killoran TP, El-Haddad G, Khaja MS, et al. Lymphatic interventions for isolated, iatrogenic chylous ascites: a multi-institution experience. Eur J Radiol 2018;109:41-47  https://doi.org/10.1016/j.ejrad.2018.10.019
  9. Nadolski GJ, Itkin M. Feasibility of ultrasound-guided intranodal lymphangiogram for thoracic duct embolization. J Vasc Interv Radiol 2012;23:613-616  https://doi.org/10.1016/j.jvir.2012.01.078
  10. Srinivasa RN, Gemmete JJ, Osher ML, Hage AN, Chick JFB. Endolymphatic balloon-occluded retrograde abdominal lymphangiography (BORAL) and embolization (BORALE) for the diagnosis and treatment of chylous ascites: approach, technical success, and clinical outcomes. Ann Vasc Surg 2018;49:49-56  https://doi.org/10.1016/j.avsg.2017.10.020
  11. Cardenas A, Chopra S. Chylous ascites. Am J Gastroenterol 2002;97:1896-1900  https://doi.org/10.1016/S0002-9270(02)04268-5
  12. Pego-Fernandes PM, Jatene FB, Tokunaga CC, Simao DT, Beirutty R, Iwahashi ER, et al. Ligation of the thoracic duct for the treatment of chylothorax in heart diseases. Arq Bras Cardiol 2003;81:309-317  https://doi.org/10.1590/S0066-782X2003001100011
  13. Khalilzadeh O, Baerlocher MO, Shyn PB, Connolly BL, Devane AM, Morris CS, et al. Proposal of a new adverse event classification by the Society of Interventional Radiology standards of practice committee. J Vasc Interv Radiol 2017;28:1432-1437.e3  https://doi.org/10.1016/j.jvir.2017.06.019
  14. Lee H, Kim SJ, Hur S, Kim HS, Min SI, Lee JH, et al. The feasibility of mesenteric intranodal lymphangiography: its clinical application for refractory postoperative chylous ascites. J Vasc Interv Radiol 2018;29:1290-1292  https://doi.org/10.1016/j.jvir.2018.01.789
  15. 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;19:285-290  https://doi.org/10.1016/j.jvir.2007.10.025
  16. 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;15:724-732 https://doi.org/10.3348/kjr.2014.15.6.724