Successful treatment of chylous ascites by superselective embolization of the inflowing lymphatic vessels using a steerable microcatheter: a case study

Radiology Case Reports

article

Shingo Hamaguchi¹  Yoshihiro Michigami¹  Masanori Inoue¹  Kaoru Tsukamoto¹  Shinji Wada¹  Yukihisa Ogawa¹ 

[1] Department of Radiology, St. Marianna University School of Medicine

关键词: Chylous ascites;    Lymphatic drainage;    Lymphatic vessels;    Steearable microcatheter;    Superselective embolization;   

DOI  :  10.1016/j.radcr.2022.06.011

学科分类：生物化学工程

来源: University of Washington * Department of Radiology

【 摘 要 】

Background Chylous ascites resulting from postoperative lymphatic leaks are uncommon but difficult to treat in cases with unsuccessful conservative treatment. Case report We report the case of an 80-year-old woman who had previously undergone multiple procedures for peritoneal dissemination 3.5 months after a laparoscopic bilateral salpingo-oophorectomy for ovarian cancer. After hospital discharge, she gradually gained weight, and examination findings indicated lymphatic leakage. We performed drainage using an 8.5-French Dawson–Mueller catheter, but more aggressive treatment was deemed necessary. We determined that it would be difficult to fill the large space, in which the leaking lymph fluid was accumulating, with embolic materials. Therefore, we performed superselective embolization of these inflowing lymphatic vessels to allow control of the chylous ascites. To overcome the technical difficulty associated with the insertion of a microcatheter from a large leakage cavity into a small inflow lymphatic vessel, we adopted a triple coaxial system that utilizes a steerable microcatheter. Successful embolization resulted in marked decrease in drainage. Follow-up computed tomography revealed no evidence of reaccumulation of chylous ascites. A three-month follow-up revealed no recurrence of lymphatic leakage. Conclusions To our knowledge, this is the first report on the treatment of large retropenitoneal chylous leakage by superselective embolization of the inflowing lymphatic vessels using steerable microcatheters. This method allows large lymphatic leaks to be treated with only a small amount of N-butyl 2-cyanoacrylate mixture and without the use of coils, and we firmly believe that it should be considered for the treatment of large refractory chylous ascites.

【 授权许可】

CC BY|CC BY-NC-ND