Pan F, Loos M, Do T D, Richter G M, Kauczor H U, Hackert T, Sommer C M
Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120, Heidelberg, Germany.
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
CVIR Endovasc. 2020 Oct 21;3(1):79. doi: 10.1186/s42155-020-00146-x.
In the management of patients with postoperative lymphatic fistula (LF) in different locations, iodized oil-based lymphangiography (LAG) from trans-pedal or intranodal route is an established diagnostic approach with the potential to plan further interventional treatments. However, specific lymphatic interventions are indicated depending on different locations and morphologies of the LF. After a systematic literature review, four types of interventions can be considered, including direct leakage embolization/sclerotherapy (DLE/DLS), percutaneous afferent lymphatic vessel embolization (ALVE), percutaneous afferent lymphatic vessels disruption/sclerotherapy (ALVD/ALVS), and trans-afferent nodal embolization (TNE). In the iodized oil-based LAG, three potential lymphatic targets including confined leakage, definite afferent LVs, and definite closest afferent LNs should be comprehensively assessed. For optimal prospective treatment planning for LF, iodized oil-based post-lymphangiographic computed tomography (post-LAG CT) is a useful complement to the conventional iodized oil-based LAG, which can be performed easily after LAG. This review article summarized the current evidence of the specific lymphatic interventions in patients with postoperative LF and explored the potential benefits of post-LAG CT in the intervention planning from a case series.
在不同部位的术后淋巴瘘（LF）患者的管理中，经足背或节点内途径的碘化油淋巴管造影（LAG）是一种既定的诊断方法，有潜力规划进一步的介入治疗。然而，具体的淋巴干预措施需根据LF的不同部位和形态来确定。经过系统的文献综述，可以考虑四种类型的干预措施，包括直接渗漏栓塞/硬化治疗（DLE/DLS）、经皮传入淋巴管栓塞（ALVE）、经皮传入淋巴管破坏/硬化治疗（ALVD/ALVS）和经传入节点栓塞（TNE）。在碘化油LAG中，应综合评估三个潜在的淋巴目标，包括局限性渗漏、明确的传入淋巴管和明确的最接近传入淋巴结。为了对LF进行最佳的前瞻性治疗规划，碘化油淋巴管造影后计算机断层扫描（LAG后CT）是传统碘化油LAG的有用补充，在LAG后可轻松进行。这篇综述文章总结了术后LF患者特定淋巴干预措施的当前证据，并从一个病例系列探讨了LAG后CT在干预规划中的潜在益处。
