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Successful treatment of chylous ascites by superselective embolization of the inflowing lymphatic vessels using a steerable microcatheter: a case study()

BACKGROUND: Chylous ascites resulting from postoperative lymphatic leaks are uncommon but difficult to treat in cases with unsuccessful conservative treatment. CASE REPORT: We report the case of an 80-year-old woman who had previously undergone multiple procedures for peritoneal dissemination 3.5 mo...

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Autores principales: Hamaguchi, Shingo, Michigami, Yoshihiro, Inoue, Masanori, Tsukamoto, Kaoru, Wada, Shinji, Ogawa, Yukihisa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9253846/
https://www.ncbi.nlm.nih.gov/pubmed/35801127
http://dx.doi.org/10.1016/j.radcr.2022.06.011
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author Hamaguchi, Shingo
Michigami, Yoshihiro
Inoue, Masanori
Tsukamoto, Kaoru
Wada, Shinji
Ogawa, Yukihisa
author_facet Hamaguchi, Shingo
Michigami, Yoshihiro
Inoue, Masanori
Tsukamoto, Kaoru
Wada, Shinji
Ogawa, Yukihisa
author_sort Hamaguchi, Shingo
collection PubMed
description BACKGROUND: Chylous ascites resulting from postoperative lymphatic leaks are uncommon but difficult to treat in cases with unsuccessful conservative treatment. CASE REPORT: We report the case of an 80-year-old woman who had previously undergone multiple procedures for peritoneal dissemination 3.5 months after a laparoscopic bilateral salpingo-oophorectomy for ovarian cancer. After hospital discharge, she gradually gained weight, and examination findings indicated lymphatic leakage. We performed drainage using an 8.5-French Dawson–Mueller catheter, but more aggressive treatment was deemed necessary. We determined that it would be difficult to fill the large space, in which the leaking lymph fluid was accumulating, with embolic materials. Therefore, we performed superselective embolization of these inflowing lymphatic vessels to allow control of the chylous ascites. To overcome the technical difficulty associated with the insertion of a microcatheter from a large leakage cavity into a small inflow lymphatic vessel, we adopted a triple coaxial system that utilizes a steerable microcatheter. Successful embolization resulted in marked decrease in drainage. Follow-up computed tomography revealed no evidence of reaccumulation of chylous ascites. A three-month follow-up revealed no recurrence of lymphatic leakage. CONCLUSIONS: To our knowledge, this is the first report on the treatment of large retropenitoneal chylous leakage by superselective embolization of the inflowing lymphatic vessels using steerable microcatheters. This method allows large lymphatic leaks to be treated with only a small amount of N-butyl 2-cyanoacrylate mixture and without the use of coils, and we firmly believe that it should be considered for the treatment of large refractory chylous ascites.
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spelling pubmed-92538462022-07-06 Successful treatment of chylous ascites by superselective embolization of the inflowing lymphatic vessels using a steerable microcatheter: a case study() Hamaguchi, Shingo Michigami, Yoshihiro Inoue, Masanori Tsukamoto, Kaoru Wada, Shinji Ogawa, Yukihisa Radiol Case Rep Case Report BACKGROUND: Chylous ascites resulting from postoperative lymphatic leaks are uncommon but difficult to treat in cases with unsuccessful conservative treatment. CASE REPORT: We report the case of an 80-year-old woman who had previously undergone multiple procedures for peritoneal dissemination 3.5 months after a laparoscopic bilateral salpingo-oophorectomy for ovarian cancer. After hospital discharge, she gradually gained weight, and examination findings indicated lymphatic leakage. We performed drainage using an 8.5-French Dawson–Mueller catheter, but more aggressive treatment was deemed necessary. We determined that it would be difficult to fill the large space, in which the leaking lymph fluid was accumulating, with embolic materials. Therefore, we performed superselective embolization of these inflowing lymphatic vessels to allow control of the chylous ascites. To overcome the technical difficulty associated with the insertion of a microcatheter from a large leakage cavity into a small inflow lymphatic vessel, we adopted a triple coaxial system that utilizes a steerable microcatheter. Successful embolization resulted in marked decrease in drainage. Follow-up computed tomography revealed no evidence of reaccumulation of chylous ascites. A three-month follow-up revealed no recurrence of lymphatic leakage. CONCLUSIONS: To our knowledge, this is the first report on the treatment of large retropenitoneal chylous leakage by superselective embolization of the inflowing lymphatic vessels using steerable microcatheters. This method allows large lymphatic leaks to be treated with only a small amount of N-butyl 2-cyanoacrylate mixture and without the use of coils, and we firmly believe that it should be considered for the treatment of large refractory chylous ascites. Elsevier 2022-06-29 /pmc/articles/PMC9253846/ /pubmed/35801127 http://dx.doi.org/10.1016/j.radcr.2022.06.011 Text en © 2022 The Authors. Published by Elsevier Inc. on behalf of University of Washington. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Hamaguchi, Shingo
Michigami, Yoshihiro
Inoue, Masanori
Tsukamoto, Kaoru
Wada, Shinji
Ogawa, Yukihisa
Successful treatment of chylous ascites by superselective embolization of the inflowing lymphatic vessels using a steerable microcatheter: a case study()
title Successful treatment of chylous ascites by superselective embolization of the inflowing lymphatic vessels using a steerable microcatheter: a case study()
title_full Successful treatment of chylous ascites by superselective embolization of the inflowing lymphatic vessels using a steerable microcatheter: a case study()
title_fullStr Successful treatment of chylous ascites by superselective embolization of the inflowing lymphatic vessels using a steerable microcatheter: a case study()
title_full_unstemmed Successful treatment of chylous ascites by superselective embolization of the inflowing lymphatic vessels using a steerable microcatheter: a case study()
title_short Successful treatment of chylous ascites by superselective embolization of the inflowing lymphatic vessels using a steerable microcatheter: a case study()
title_sort successful treatment of chylous ascites by superselective embolization of the inflowing lymphatic vessels using a steerable microcatheter: a case study()
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9253846/
https://www.ncbi.nlm.nih.gov/pubmed/35801127
http://dx.doi.org/10.1016/j.radcr.2022.06.011
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