13th Annual Global Embolization Symposium & Technologies
Purpose : Glue is the mostly used agent for occlusion of lymphatic vessels in the treatment of post-surgical and congenital lymphatic leaks. The purpose of the current study was to gain initial experience in the use of the detergent sclerosant sodium tetradecyl sulfate as a safe and efficient alternative.
Material and Methods : Four patients were included in this study. Two patients had abdominal lymphatic leaks after surgery (inguinal hernia repair and pelvic cancer surgery) and two patients suffered from congenital lymphatic leaks (scrotal chyle leak and thoracic duct cyst). All patients underwent diagnostic nodal lymphangiography with Lipiodol before sclerotherapy. The leaks after surgery were treated by injection of sodium tetradecyl sulfate in inguinal lymph nodes allowing the sclerosant to reach the leakage site through efferent lymphatic vessels. Direct puncture and injection of the sclerosant was used treat the thoracic duct cyst. The retrograde flow of chyle to scrotum was treated by direct puncture of an enlarged inguinal lymphatic vessel with retrograde flow of lymphatic fluid to the scrotum. Procedures were performed using fluoroscopy with patients under conscious sedation.
Results : All patients showed a prompt response with complete cessation of lymphatic leaks. One of the patients with post-surgical leaks after pelvic surgery, developed leg lymphedema which ceased after a couple of months. To avoid leg lymphedema, extra care was taken for the second patient with inguinal/pelvic leak. Super selective sclerotherapy by targeting only lymph nodes with efferent flow to the leakage site was effective without post-procedure leg lymphedema. Resolution of the thoracic duct cyst was verified by MRI.
Conclusions : Detergent sclerosants seems efficient and safe in the treatment of various lymphatic leaks. A potential advantage for detergent sclerosants is their ability to spread longer distances and into smaller lymphatic vessels due to the lower viscosity of the agent compared to glue which is diluted with the viscous contrast agent Lipiodol.