title: Early Experience in the Management of Postoperative Lymphatic Leakage Using Lipiodol Lymphangiography and Adjunctive Glue Embolization.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of Lipiodol lymphangiography and 3 adjunctive N-butyl cyanoacrylate (NBCA) glue embolization techniques for the management of postoperative lymphatic leakage.
  
  
  METHODS
  This retrospective study included 27 patients with postoperative lymphatic leakage (17 with ascites, 3 with chylothorax, 6 with lymphoceles, and 1 with a skin fistula) who underwent Lipiodol lymphangiography for diagnostic and therapeutic purposes in 3 tertiary referral centers between August 2010 and January 2016. Adjunctive glue embolization was performed as needed by using 3 different techniques: "lymphopseudoaneurysm" embolization, closest upstream lymph node embolization, or direct upstream lymphatic vessel embolization.
  
  
  RESULTS
  Sixteen patients were observed to determine the therapeutic effect of lymphangiography, and 8 patients (50%) recovered without further embolization. In 16 patients, including 11 who underwent immediate embolization after lymphangiography and 5 who underwent delayed embolization, a total of 28 embolizations (12 lymphopseudoaneurysms, 14 lymph nodes, and 2 lymphatic vessels) were performed. The technical and clinical success rates of the adjunctive embolizations were 89% (25 of 28) and 94% (15 of 16), respectively. The overall clinical success rate was 85% (23 of 27). The median time from initial lymphangiography to recovery was 5 days. No procedure-related major complications were reported.
  
  
  CONCLUSIONS
  Lipiodol lymphangiography and adjunctive glue embolization techniques appear safe and provide promising efficacy for the management of postoperative lymphatic leakage.
authors.affiliation: From the Departments of Radiology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Saebeom
authors.initials: S
authors.lastname: Hur
authors.affiliation: Department of Radiology, Asan Medical Center, Seoul, Korea. Electronic address: jhshin@amc.seoul.kr.
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Shin
authors.affiliation: Department of Radiology, National Cancer Center, Goyang, Korea.
authors.forename: In Joon
authors.initials: IJ
authors.lastname: Lee
authors.affiliation: Surgery, Seoul National University Hospital, Seoul, Korea.
authors.forename: Seung-Kee
authors.initials: SK
authors.lastname: Min
authors.affiliation: Surgery, Seoul National University Hospital, Seoul, Korea.
authors.forename: Sang-Il
authors.initials: SI
authors.lastname: Min
authors.affiliation: Surgery, Seoul National University Hospital, Seoul, Korea.
authors.forename: Sanghyun
authors.initials: S
authors.lastname: Ahn
authors.affiliation: Department of Radiology, Ajou University Hospital, Suwon, Korea.
authors.forename: Jinoo
authors.initials: J
authors.lastname: Kim
authors.affiliation: From the Departments of Radiology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Sang Youn
authors.initials: SY
authors.lastname: Kim
authors.affiliation: From the Departments of Radiology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Minuk
authors.initials: M
authors.lastname: Kim
authors.affiliation: From the Departments of Radiology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Myungsu
authors.initials: M
authors.lastname: Lee
authors.affiliation: From the Departments of Radiology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Hyo-Cheol
authors.initials: HC
authors.lastname: Kim
authors.affiliation: From the Departments of Radiology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Hwan Jun
authors.initials: HJ
authors.lastname: Jae
authors.affiliation: From the Departments of Radiology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Jin Wook
authors.initials: JW
authors.lastname: Chung
authors.affiliation: Department of Radiology, National Cancer Center, Goyang, Korea.
authors.forename: Hyun Beom
authors.initials: HB
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D002916:Chylothorax / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D003287:Contrast Media / Q000008:administration & dosage* / Q000009:adverse effects; D017577:Cutaneous Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D004659:Enbucrilate / Q000008:administration & dosage* / Q000009:adverse effects; D004998:Ethiodized Oil / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D008210:Lymphocele / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D008220:Lymphography / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D011237:Predictive Value of Tests; D056910:Republic of Korea; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D004998:Ethiodized Oil; D004659:Enbucrilate