Mesenteric Lymphangiography as a New Diagnostic and Therapeutic Tool for Refractory Chylous Lymphatic Leakages and...

To evaluate whether mesenteric lymphangiography (mLAG) is technically feasible and clinically useful for patients with refractory chylous ascites, chylothorax, and protein-losing enteropathy (PLE).

A retrospective study of 35 patients (male, 16; female, 19; mean age, 56 years; range, 20-78 years) who underwent mLAG at 2 institutions between March 2016 and July 2022 was performed. mLAG was performed via intraoperative and/or percutaneous approaches. Imaging findings were categorized into 3 types: Type 0 (technical failure), Type 1 (limited to mesentery), or Type 2 (central propagation). Auxiliary findings including lymphangiectasia, reflux, and leakage were recorded. Interventions included mesenteric lymph node embolization (mLNE), retroperitoneal lymph node embolization, lymphoplasty, and lymphovenous shunt creation.

Among 35 patients, 27 presented with refractory chylous ascites and/or chylothorax and 8 with PLE. Of the 35 patients, mLAG was performed percutaneously in 21 (60%) patients, intraoperatively in 9 (26%), and both percutaneously and intraoperatively in 5 (14%) patients. The findings were classified as Type 0 in 4 (11%), Type 1 in 8 (23%), and Type 2 in 23 (66%). Of 35 patients, the auxiliary findings of lymphangiectasia (E), reflux (R), and leakage (L) were observed in 20% (n = 7), 23% (n = 8), and 6% (n = 2), respectively. mLNE was performed in 14 patients. Clinical improvement was achieved in 57% (20 of 35) of the patients. One patient developed bowel wall edema post-mLNE; no other severe adverse event was reported.

mLAG is technically feasible and safe. It can be a useful tool to image the mesenteric lymphatics or perform mesenteric lymphatic embolization.