Therapeutic lymphangiography with ethiodized oil for the management of lymphoceles and chylous ascites.

PURPOSE: The purpose of this study was to analyze the safety, technical success and clinical outcome of percutaneous intranodal ethiodized oil (Lipiodol®) based lymphangiography (L-LAG) for the management of refractory pelvic lymphoceles or chylous ascites using high doses of ethiodized oil. MATERIALS AND METHODS: Thirty-four patients presenting with symptomatic, refractory postoperative pelvic lymphocele or chylous ascites referred for theranostic, inguinal, intranodal L-LAG treatment between May 2018 and November 2021 were retrospectively included. There were 21 men and 13 women, with a mean age of 62.7 ± 16.2 (standard deviation) years (age range: 9-86 years), who underwent a total of 49 L-LAG for the management of lymphoceles (n = 14), chylous ascites (n = 18) or a combination of lymphocele and chylous ascites (n = 2). Clinical and radiological pre-interventional, procedural and follow-up data up to January 2022 were collected from patients' electronic medical records and imaging files. RESULTS: Technical success was obtained in 48 out of 49 L-LAG (98%). No complications related to L-LAG were noted. After one or more L-LAG, clinical success was obtained in 30 patients (88%) with a mean of 1.4 interventions per patient and mean intranodal injected volume of 29 mL of ethiodized oil per session. The remaining four patients (12%), with one or more failed L-LAG, underwent additional surgical intervention to definitively treat the postoperative lymphatic leakage. CONCLUSION: L-LAG using high doses of ethiodized oil is a minimally invasive, safe and effective treatment of postoperative pelvic lymphocele or chylous ascites. Multiple sessions may be needed to obtain a meaningful clinical result.

Long-Term Outcome of Single-Session, Ultrasound-Guided, Radiofrequency Ablation for Symptomatic Small, Lower Limb, Venous Malformations.

Objectives: To analyze the long-term clinical outcome of percutaneous, ultrasound-guided radiofrequency ablation (RFA) of peripheral low-flow vascular malformations (VM). Materials & Methods: Adolescent patients presenting with symptomatic VMs and referred for percutaneous management using RFA between January 2010 and January 2015 were identified by a search in the institutional interventional radiology database. Clinical and radiological follow-up up to April 2021 was based on retrospective analysis of patients' electronic medical records and imaging files. This retrospective study was approved by the institutional ethics committee. Results: Four female patients (median age 16 years) presented with lower extremity pain, swelling and functional disability related to VM as confirmed by magnetic resonance imaging. Two patients underwent percutaneous sclerotherapy previously. Clinical follow-up (mean of 8,5 years) showed complete and sustained resolution of the symptoms in all patients; in one patient a persistent decrease in muscular strength of the treated limb was noted. Conclusion: Percutaneous, ultrasound-guided RFA is relatively safe and efficient with durable symptom relief in the management of small, lower limb VMs in adolescent patients.

Postoperative lymphocele causing obturator nerve entrapment, treated with percutaneous drainage and intranodal poppyseed oil (Lipiodol)-based lymphangiography.

Obturator nerve entrapment is a rare complication after pelvic surgery and is caused by a direct intraoperative injury or secondary to compression by a postoperative collection. We have presented the case of a 65-year-old man who had complained of right-sided medial groin pain 4 weeks after robot-assisted laparoscopic prostatectomy with bilateral pelvic lymphadenectomy. Pelvic magnetic resonance imaging showed bilateral lymphoceles with right-sided compression of the obturator nerve causing diffuse muscle edema in its innervation region. Percutaneous drainage and intranodal poppyseed oil (Lipiodol)-based lymphangiography led to a complete resolution of his symptoms.