Efficacy and Comparative Multivariate Analysis of Intranodal Lymphangiography with Percutaneous Intervention for Chylous Leaks

Objective: Intranodal lymphangiography (INL) is a novel technique for lymphatic intervention. INL’s efficacy and comparison between different lymphatic percutaneous interventions and procedural techniques has not been studied extensively.

Materials and Methods: All INLs over 4 years were included. Patient demographics and procedural technical variables were recorded. Time to resolution or subsequent intervention was documented. Clinical success was defined as resolution of chylous effusion without additional surgery. Fisher’s exact test and logistic regression were used for statistical analysis.

Results: Sixty-one patients underwent INL alone or in conjunction with thoracic duct embolization (TDE) or thoracic duct disruption (TDD). INL was technically successful in 60/61 patients (98%). There were no major and two minor complications. Clinical success rate was 42/60 (70%). Identification of a leak on fluoroscopy had no effect on outcome (p = 0.38).

Clinical success and median time to resolution with INL only was 12/20 (60%) and 14 days; INL and TDD was 9/16 (53.3%) and 9 days; INL and TDE was 21/24 (87.5%) and 3 days. There was no difference in clinical success between INL and TDD and INL only groups (p = 0.55).

Number of groin nodes injected, drain output of chyle per day, or volume of ethiodized oil had no effect on clinical success.

Conclusion: INL is safe, has similar technical and clinical efficacy as pedal lymphangiography, and likely results in decreased procedure times. No benefit was identified between INL with TDD versus INL alone. Number of groins lymph nodes injected, amount of ethiodized oil used, and visualization of a leak on fluoroscopy did not affect clinical success.

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