Percutaneous lymphatic duct embolisation in postnephrectomy chylous ascites.

Area of Science:

• Interventional Radiology
• Vascular Surgery
• Nephrology

Background:

• Chylous ascites arises from lymphatic system compromise due to surgery, tumors, or other complications.
• It involves lymphatic vessel blockage or leakage, leading to abdominal fluid accumulation.
• Conservative treatments often fail, necessitating alternative interventions.

Purpose of the Study:

• To report a case of chylous ascites following left nephrectomy for renal cell carcinoma.
• To demonstrate the efficacy of lymphangiography and embolization in treating refractory chylous ascites.
• To highlight a minimally invasive approach for managing lymphatic leaks.

Main Methods:

• Diagnostic lymphangiography to identify the chylous leak site near the left renal hilum.
• Fluoroscopically guided transabdominal puncture with a Chiba needle.
• Embolization using n-butyl cyanoacrylate/Lipiodol and Onyx to seal the lymphatic duct leak.

Main Results:

• Successful identification of the chylous leak through lymphangiography.
• Effective embolization of the lymphatic duct using a combination of agents.
• Resolution of chylous ascites in a patient refractory to conservative management.

Conclusions:

• Lymphangiography with embolization is a safe and effective minimally invasive treatment for chylous ascites.
• This technique offers a viable option for patients with lymphatic leaks unresponsive to conventional therapies.
• Selective embolization provides targeted treatment for lymphatic duct injuries.