Lymphatic leak occurring after surgical lymph node dissection: a preliminary study
assessing the feasibility and outcome of lymphatic embolization⁽¹¹⁾

Embolization technique. For embolization, a 1:1 mixture of NBCA and Lipiodol^® was used for the first two techniques, while the mixture was between 1:6 and 1:8 for the third technique.

Outcome: Intranodal lymphangiography was successfully performed on both sides in 19 patients (90.5 %) […]
17 patients (81.0 %) showed initial response to treatment. Three patients underwent repeated embolization with successful results.
The overall success rate was 95.2 %.

LIPIODOL^® & NBCA – FOR LYMPHATIC LEAK

	A Technique 1: the leak (white arrow) was targeted under fluoroscopic guidance using a 22-gauge needle (black arrow) through which NBCA was injected.
	B Technique 2: the inflow vessel leading to the leak (white arrow) was puncturedusing a 22-gauge needle (black arrow) and NBCA was injected.
	C Technique 3: NBCA was injected into a pelvic lymph node (black arrows) to treat multifocal leaks (white arrows).

Therapeutic strategy for chylous leakage after esophagectomy: focusing on lymphangiography using Lipiodol^®(12)

A Main trunk type: the patient underwent esophagectomy with a combined resection of the thoracic duct. A chest radiograph shows that the thoracic duct was visualized in the lower mediastinum (black arrow). A large pooling of contrast medium leaked from the stump of thoracic duct (white arrow).

B Branch type: the patient underwent esophagectomy with the combined resection of thoracic duct. The black arrowhead shows the stump of the right-sided thoracic duct which was successfully ligated in the preceded esophagectomy. However, the leftsided thoracic duct (black arrow) was patent, and the segmental plexus formation of the lymphatic vessels was observed in the lower mediastinum. Pooled contrast medium was leaked from the plexus formation of the lymphatic vessels (white arrow)

Outcome:  In all 33 patients, the therapeutic management was determined after lymphangiography, and all patients were finally healed.

LIPIODOL^® – FOR REFRACTORY POST-ESOPHAGECTOMY CHYLOUS LEAKAGE

A novel algorithm proposed for determining the optimal therapeutic strategy for the treatment of refractory chylous leakage after esophagectomy, focusing on lymphangiography using Lipiodol^{® (12)}

INSERT NEW VERSION OF IMAGE

Solution of Visualization For Abnormal Lymphatic System

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^{2.Ryota Kawasaki et al., Therapeutic Effectiveness of Diagnostic Lymphangiography for Refractory Postoperative Chylothorax and Chylous Ascites: Correlation With Radiologic Findings and Preceding Medical Treatment, AJR, 2013; 201:659–666.}

^{3.Lee BB, et al., IUA-ISVI consensus for diagnosis guideline of chronic lymphedema of the limbs, Edizioni Minerva Medica, 2014,https://www.minervamedica.it/}

^{4.Kimberly Levenhagen, et al.,, Diagnosis of Upper-Quadrant Lymphedema Secondary to Cancer: Clinical Practice Guideline From the Oncology Section of APTA, American Physical Therapy Association. Phys Ther., 2017;97: 729–745.}

^{5.Saebeom Hur, et al., Early Experience in the Management of Postoperative Lymphatic Leakage Using Lipiodol Lymphangiography and Adjunctive Glue Embolization.J VascI Interv Radiol, 2016;27:1177–1186.}

^{6.Tatjana Gruber-Rouh, et al., Direct lymphangiography as treatment option of lymphatic leakage:Indications, outcomes and role in patient’s management, European Journal of Radiology, 2014;83:2167–2171.}

^{7.Tetsuya Abe, et al., Therapeutic strategy for chylous leakage after esophagectomy: focusing on lymphangiography using lipiodol, Esophagus, 2016;13:237–244.}

^{8.Sho Kitagawa, et al., Ulrasound-Guided Intranodal Lymphangiography With Ethiodized Oil to Treat Chylous Ascites, ACG Case Rep J, 2016;3(4):e95.}

^{9.F. M. Go´mez, et al., Transnodal Lymphangiography in the Diagnosis and Treatment of Genital Lymphedema, Cardiovasc Intervent Radiol, 2012;35:1488–1491.}

^{10.Shuji Kariya, et al., Embolization for Thoracic Duct Collateral Leakage in High-Output Chylothorax After Thoracic Surgery, Cardiovasc Intervent Radiol, 2017; 40:55–60.}

^{11.Yoolim Baek, et al., Lymphatic Leak Occurring After Surgical Lymph NodeDissection: A Preliminary Study Assessing the Feasibility and Outcome of Lymphatic Embolization, Cardiovasc Intervent Radiol, 2016;39:1728–1735.}

^{12.Tetsuya Abe, et al., Therapeutic strategy for chylous leakage after esophagectomy: focusing on lymphangiography using lipiodol, Esophagus, 2016;13:237–244}