Effectiveness of therapeutic lymphography on lymphatic leakage

• Published in: Acta radiologica (1987) 2011-04, Vol.52 (3), p.305-311
• Main Authors: Alejandre-Lafont, Enrique, Krompiec, Christoph, Rau, Wigbert S, Krombach, Gabriele A
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Cardiovascular system; Child; Chylothorax - diagnostic imaging; Chylothorax - therapy; Chylous Ascites - diagnostic imaging; Chylous Ascites - therapy; Contrast Media - therapeutic use; Ethiodized Oil - therapeutic use; Female; Fistula - diagnostic imaging; Fistula - therapy; Humans; Investigative techniques, diagnostic techniques (general aspects); Lymphatic Diseases - diagnostic imaging; Lymphatic Diseases - therapy; Lymphocele - diagnostic imaging; Lymphocele - therapy; Lymphography - methods; Male; Medical sciences; Middle Aged; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Retrospective Studies; Treatment Outcome
• ISSN: 0284-1851; 1600-0455
• DOI: 10.1258/ar.2010.090356

Background The number of conventional lymphographies has declined markedly since the introduction of cross-sectional imaging techniques. Nevertheless, lymphography has a high potential as a reliable method to visualize and directly occlude lymphatic leaks. When used as a distinct radiological procedure with the intention to treat, this application can be described as therapeutic lymphography. Purpose To investigate if therapeutic lymphography is a reliable method to treat lymphatic leakage when conservative treatment fails and to investigate which parameters influence the success rate. Material and Methods Between August 1995 and January 2008, 50 patients with lymphatic leakage in form of chylothorax, chylous ascites, lymphocele, and lymphatic fistulas underwent conventional therapeutic lymphography after failure of conservative therapy. Of these 50 patients, seven could not be statistically evaluated in our retrospective study: one patient died of cancer 1 day after lymphography, and six were excluded due to various technical problems. The remaining 43 patients were evaluated. Therapeutic success was evaluated and correlated to the volume of lymphatic leakage (more or less than 500 mL/day), as assessed by drainage. Results In nearly 79% of patients, the location of the leak could be detected, and surgical intervention could be planned when therapeutic lymphography failed. Due to the irrigating effect of the contrast medium (lipiodol), the lymphatic leak could be completely occluded in 70% of patients when the lymphatic drainage volume was less than 500 mL/day. Even when lymphatic drainage was higher than 500mL/day, therapeutic lymphography was still successful in 35% of the patients. The overall success rate in patients with failed conservative treatment was 51%. Success did not depend on other factors such as age and sex, cause of lymph duct damage, or time elapsed between lymphatic injury and intervention. Conclusion Therapeutic lymphography is an effective method in the treatment of lymphatic leakage when conservative therapy fails. The volume of lymphatic drainage per day is a significant predictor of the therapeutical success rate.