Journal of vascular and interventional radiology : JVIR · 2025
Mesenteric Lymphangiography as a New Diagnostic and Therapeutic Tool for Refractory Chylous Lymphatic Leakages and Protein-Losing Enteropathy.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Lim David Yurui, Hur Saebeom, Kwon Lyo Min, Itkin Maxim
Аннотация
PURPOSE: To evaluate whether mesenteric lymphangiography (mLAG) is technically feasible and clinically useful for patients with refractory chylous ascites, chylothorax, and protein-losing enteropathy (PLE).
MATERIALS AND METHODS: 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.
RESULTS: 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.
CONCLUSIONS: mLAG is technically feasible and safe. It can be a useful tool to image the mesenteric lymphatics or perform mesenteric lymphatic embolization.
MATERIALS AND METHODS: 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.
RESULTS: 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.
CONCLUSIONS: mLAG is technically feasible and safe. It can be a useful tool to image the mesenteric lymphatics or perform mesenteric lymphatic embolization.