Glue Embolization of Lymphopseudoaneurysm for Chylous Ascites after Retroperitoneal Surgery

• Published in: Korean journal of radiology 2021, 22(3), , pp.376-383
• Main Authors: Kwon, Lyo Min, Hur, Saebeom, Jeong, Chang Wook, Jae, Hwan Jun, Chung, Jin Wook
• Format: Article
• Language: English
• Subjects: Abdomen; Adult; Ascites; Catheters; Chylous Ascites - diagnostic imaging; Chylous Ascites - therapy; Drainage; Embolization; Embolization, Therapeutic; Enbucrilate - chemistry; Ethiodized Oil - chemistry; Female; Humans; Intervention; Intubation; Lymphatic system; Lymphography - methods; Male; Medical imaging; Middle Aged; Nephrectomy; Patients; Retrospective Studies; Surgery; Testicular cancer; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonic imaging; 방사선과학
• ISSN: 1229-6929; 2005-8330
• DOI: 10.3348/kjr.2020.0056

To assess the safety and efficacy of lymphopseudoaneurysm (LPA) glue (n-butyl cyanoacrylate [NBCA]) embolization in the management of chylous ascites after retroperitoneal surgery. 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). 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). Glue embolization of LPA has the potential to be a feasible and effective treatment method for the management of chylous ascites after retroperitoneal surgery.