Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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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
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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.

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