Chylous complications of various severity and manifestations within diverse compartments in reconstructive vascular surgery #) #) The manuscript is dedicated to Prof. Dr. Z. Halloul.

INTRODUCTION

Chylous complications, which occur also in the profile of vascularsurgical interventions with considerable frequency, are challenging with regard to their adequate management. Aim & method: Compact short overview on epidemiological, classifying, symptomatic, diagnostic and therapeutic aspects of chylous complications in vascular surgery, based on i) own clinical experiences, ii) a current selection of relevant scientific references and iii) representative case reports from clinical practice. Results (complex patient- & clinical finding-associated aspects): - Basic treatment of lymphedema / postreconstructive edema comprises the complex physical therapy to improve edematous swelling, which need to be usually performed over years. - In case of lymphocele, wait-and-see strategy can be initially pursued to observe spontaneous clinical course. If the lymphocele and its clinical complaints persist, puncture, placement of a drainage or temporary instillation of doxycyclin or ethanol can be attempted. - In case of lymphatic fistula, vacuum-assisted closure dressing, radiation and selective ligation of lymphatic vessels after previous application of methylen blue dye can be used. - Chylascites and chylothorax should be primarily treated - as have been widely established in the mean time - with a consequently conservative approach comprising initially paracentesis / thoracocentesis, protein-enriched and low-fat diet containing middle chain triglycerides (MCT) or total parenteral nutrition combined with the application of a somatostatin analogue (surgical approach as ultima ratio only aiming at ligation of the lesioned lymphatic vessel - if necessary, including preoperative consumption of cream).

SUMMARY: Chylous complications can be primarily treated with conservatice measures, which should be exploited using a step-wise approach prior to surgical intervention as ultima ratio.

CONCLUSION

The experienced vascular surgeon should be aquainted with a sufficient, finding-adapted management of chylous complications. This requires a well-experienced clinician and surgeon with great expertise regarding the interdisciplinary setting comprising of interventional radiology, vascular (abdominal) surgery and partially surgical intensive care.