CLINICAL STUDY
Comparative Analysis of Intranodal Lymphangiography with Percutaneous Intervention for Postsurgical Chylous Effusions

https://doi.org/10.1016/j.jvir.2016.12.1209Get rights and content

Abstract

Purpose

To evaluate clinical success and time to resolution of intranodal lymphangiography (INL) alone or with thoracic duct embolization (TDE) or thoracic duct disruption (TDD) based on initial effusion volume for postsurgical chylothorax.

Materials and Methods

Retrospective review was performed of 57 patients (mean age 63 y; 65% male) undergoing INL alone or in conjunction with other percutaneous techniques for postsurgical chylous effusions. INL alone was performed when chylothorax output was ≤ 500 mL/d and no leak was identified during fluoroscopy.

Results

INL was technically successful in all patients. There was 1 major and 2 minor complications. Clinical success rate was 71% (40/56). Clinical success rate meeting algorithmic inclusion criteria was 71.4% (5/7) for INL only, 41.7% (5/12) in INL with TDD, and 90.5% (19/21) in INL with TDE. Hazard ratio (HR) of clinical success of INL with TDE versus INL only was not statistically significant (HR 2.3, 95% confidence interval [CI], 0.70–5.87, P = .19). Median time to resolution was 14 days for INL only (95% CI, 0 days to not reached), 7 days for INL with TDD (95% CI, 4 days to not reached), and 3 days for INL with TDE (95% CI, 2 to 5 days) (P = .007). No statistically significant difference in median time to resolution existed between INL with TDE and INL only (P = .04).

Conclusion

In patients with postsurgical chylothorax, INL alone had similar rates of clinical success and time to resolution compared with INL with TDE when initial effusion volume was ≤ 500 mL/d and no leak was visualized during fluoroscopy.

Section snippets

Study Cohort

This retrospective, institutional review board–approved, Health Insurance Portability and Accountability Act–compliant study was conducted with a study cohort of 57 patients (26 women, 31 men; mean age, 63 y, age range, 11–84 y) (Table 1). Informed consent was waived per institutional review board protocol. Ten patients underwent lymphatic intervention apart from INL only, INL with TDE, or INL with TDD. One patient was immediately lost to follow-up. Seven patients did not meet algorithmic

Results

Mean daily effusion output was 1,063 mL (range, 200–3,000 mL). Mean Lipiodol injected was 8.5 mL (range, 4–15 mL). There was no difference in sex distribution of patients undergoing INL with TDE, INL with TDD, or INL only (INL with TDE, 66.7% male; INL with TDD, 50% male; INL only, 50% male; P = .51), although the mean age of patients in the INL only group was younger compared with the other groups (INL with TDE, mean 66.5 y [range, 47–83 y]; INL with TDD, mean 67.1 y [range, 50–81 y]; INL

Discussion

INL has hitherto been an understudied intervention for management of chylous effusions. Previous studies evaluating the clinical success rate with BPL with TDE or TDD have reported rates of 45%–74% (10, 12, 13, 14). A recently published study mostly using INL to access the lymphatic system for abdominal intervention documented a clinical success rate of 94% (21). The present study documented an overall clinical success rate of all image-guided percutaneous interventions of 71%. Clinical and

References (26)

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None of the authors have identified a conflict of interest.

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