Learning objectives
In this educational exhibit,
the role of transpedal lymphangiography and different percutaneous lymphatic second-line interventions with intention to cure post-operative therapy-refractory lymphatic fistula in the groin region is outlined.
Technical and clinical aspects are presented in the form of a pictorial essay.
Background
Post-operative therapy-refractory lymphatic fistula in the groin region is a therapeutic challenge [1-4].
Affected patients suffer from a reduced quality of life (e.g.
due to wound healing disorders) and are subject to risk from life-threatening comorbidity (e.g.
due to malnutrition and immunodeficiency) (Figure 1) [5].
Regularly,
different time-consuming and often cost-intensive and clinically ineffective medical and surgical treatments are performed before specific radiological lymphatic treatment is indicated [6].
Findings and procedure details
Transpedal lymphangiography:
Transpedal lymphangiography applying iodized oil as contrast and occlusion material and radiography and CT as imaging modalities is the first-line approach to visualize type (e.g.
lymphopseudoaneurysm or lymphocele),
degree (e.g.
unifocal or multifocal) and exact location (e.g.
efferent to lymph nodes) of post-operative therapy-refractory lymphatic fistula in the groin region.
The major steps of transpedal lymphangiography -includingpreparation,
cut-down and iodized oil application - is presented in Figures 2 and 3.
In a considerable number of patients,
transpedal lymphangiography alone is a curative treatment...
Conclusion
Transpedal lymphangiography and different percutaneous lymphatic second-line interventions are feasible,
safe,
and effective to cure post-operative therapy-refractory lymphatic fistula in the groin region.
The radiological treatment should be indicated in the early post-operative course with intention to minimize physical and mental suffering of patients,
and additionallyto decrease healthcare provider costs.
Personal information
Corresponding Author
Christof M Sommer,
Priv.-Doz.
Dr.
med.,
MD
Stuttgart Clinics
Clinic for Diagnostic and Interventional Radiology
Kriegsbergstrasse 60
70174 Stuttgart
Germany
Phone: +49 (0)711 27834400
Fax: +49 (0)711 27834409
Email
[email protected]
/
University Hospital Heidelberg
Clinic for Diagnostic and Interventional Radiology
INF 110
69120 Heidelberg
Germany
Phone:+49 (0)6221 5638534
Fax:+49 (0)6221 564194
Email
[email protected]
References
Hur S,
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Min SK,
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Ahn S,
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Kim SY,
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Lee M et al: Early Experience in the Management of Postoperative Lymphatic Leakage Using Lipiodol Lymphangiography and Adjunctive Glue Embolization.
Journal of vascular and interventional radiology : JVIR 2016,
27(8):1177-1186 e1171.
Inoue M,
Nakatsuka S,
Yashiro H,
Tamura M,
Suyama Y,
Tsukada J,
Ito N,
Oguro S,
Jinzaki M: Lymphatic Intervention for Various Types of Lymphorrhea: Access and Treatment.
Radiographics : a review publication of the Radiological...