title: Effectiveness of therapeutic lymphography on lymphatic leakage.
abstract: BACKGROUND
  The number of conventional lymphographies has declined markedly since the introduction of cross-sectional imaging techniques. Nevertheless, lymphography has a high potential as a reliable method to visualize and directly occlude lymphatic leaks. When used as a distinct radiological procedure with the intention to treat, this application can be described as therapeutic lymphography.
  
  
  OBJECTIVE
  To investigate if therapeutic lymphography is a reliable method to treat lymphatic leakage when conservative treatment fails and to investigate which parameters influence the success rate.
  
  
  METHODS
  Between August 1995 and January 2008, 50 patients with lymphatic leakage in form of chylothorax, chylous ascites, lymphocele, and lymphatic fistulas underwent conventional therapeutic lymphography after failure of conservative therapy. Of these 50 patients, seven could not be statistically evaluated in our retrospective study: one patient died of cancer 1 day after lymphography, and six were excluded due to various technical problems. The remaining 43 patients were evaluated. Therapeutic success was evaluated and correlated to the volume of lymphatic leakage (more or less than 500 mL/day), as assessed by drainage.
  
  
  RESULTS
  In nearly 79% of patients, the location of the leak could be detected, and surgical intervention could be planned when therapeutic lymphography failed. Due to the irrigating effect of the contrast medium (lipiodol), the lymphatic leak could be completely occluded in 70% of patients when the lymphatic drainage volume was less than 500 mL/day. Even when lymphatic drainage was higher than 500 mL/day, therapeutic lymphography was still successful in 35% of the patients. The overall success rate in patients with failed conservative treatment was 51%. Success did not depend on other factors such as age and sex, cause of lymph duct damage, or time elapsed between lymphatic injury and intervention.
  
  
  CONCLUSIONS
  Therapeutic lymphography is an effective method in the treatment of lymphatic leakage when conservative therapy fails. The volume of lymphatic drainage per day is a significant predictor of the therapeutical success rate.
authors.affiliation: Department of Radiology, Justus Liebig University Giessen, Germany. Enrique.alejandre-lafont@radiol.med.uni-giessen.de
authors.forename: Enrique
authors.initials: E
authors.lastname: Alejandre-Lafont
authors.forename: Christoph
authors.initials: C
authors.lastname: Krompiec
authors.forename: Wigbert S
authors.initials: WS
authors.lastname: Rau
authors.forename: Gabriele A
authors.initials: GA
authors.lastname: Krombach
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002916:Chylothorax / Q000000981:diagnostic imaging* / Q000628:therapy*; D002915:Chylous Ascites / Q000000981:diagnostic imaging* / Q000628:therapy*; D003287:Contrast Media / Q000627:therapeutic use; D004998:Ethiodized Oil / Q000627:therapeutic use; D005260:Female; D005402:Fistula / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging* / Q000628:therapy*; D008210:Lymphocele / Q000000981:diagnostic imaging / Q000628:therapy; D008220:Lymphography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D004998:Ethiodized Oil