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A Novel Technique in the Treatment of Lymphoceles After Renal Transplantation

C-Arm Cone Beam CT-Guided Percutaneous Embolization of Lymphatic Leakage After Lymphangiography

Yildirim, İsmail Okan, MD1; Pişkin, Turgut, MD2; Duman, Enes, MD3; Firat, Ali, MD4; Dogan, Murat, MD2; Taskapan, Hülya, MD5; Sahin, Idris, MD5; Sarac, Kaya, MD1

doi: 10.1097/TP.0000000000002268
Original Clinical Science—General

Background We aimed to evaluate the efficacy of percutaneous embolization after lymphangiography using C-arm cone-beam computed tomography (CBCT) performed at the site of lymphatic leakage in patients with postrenal transplant lymphocele.

Methods Between July 2014 and August 2017, 13 patients not responding to percutaneous ethanol sclerotherapy and conservative treatment for recurrent lymphocele after renal transplant were included. The mean age of the patients was 56.38 ± 9.91 (range, 36-70) years, and it comprised 9 men and 4 women. All patients underwent intranodal lymphangiography. C-arm CBCT-guided percutaneous embolization was performed in patients with confirmed lymphatic leakage. Patients who had no lymphatic leakage underwent drainage with fibrin glue injection.

Results Lymphatic leakage was observed in 9 patients after lymphangiography, and they underwent CBCT-guided percutaneous N-butyl-2-cyanoacrylate embolization. The volume of lymphatic drainage reduced to less than 10 mL in 8 patients. One patient who was not responding to embolization was treated surgically, after percutaneous drainage and fibrin glue injection. Lymphatic leakage was not observed in 4 patients after lymphangiography. Of these, 3 patients showed a reduction in the amount of lymphatic drainage after lymphangiography. All 4 patients underwent percutaneous drainage and fibrin glue injection. One patient did not respond to the treatment and was treated surgically. Prelymphangiography and postlymphangiography and embolization, the volume of lymphatic drainage was 113.07 ± 21.75 mL, and 53.84 ± 30.96 mL, respectively, and statistically significant decrease was detected (P < 0.005).

Conclusions Lymphangiography and CBCT-guided percutaneous embolization procedures might be an effective treatment method for patients with lymphocele refractory to treatment.

Lymphangiography and C-arm cone-beam computed tomography guided percutaneous embolization procedures may be an effective treatment method for patients with lymphocele refractory to treatment.

1 Department of Radiology, Inonu University Faculty of Medicine, Malatya, Turkey.

2 Division of Kidney Transplantation, Inonu University Faculty of Medicine, Malatya, Turkey.

3 Department of Radiology, Başkent University Faculty of Medicine, Konya, Turkey.

4 Department of Radiology, Başkent University Faculty of Medicine, Istanbul, Turkey.

5 Department of Nephrology, Inonu University Faculty of Medicine, Malatya, Turkey.

Received 24 January 2018. Revision received 16 April 2018.

Accepted 26 April 2018.

The authors declare no funding or conflicts of interest.

I.O.Y., H.T. participated in research design. I.O.Y., T.P., M.D. participated in the writing of the article. I.O.Y., E.D., A.F., M.D., K.S. participated in the performance of the research. I.S., E.D., A.F. contributed new reagents or analytic tools. I.O.Y., T.P., K.S., M.D. participated in data analysis.

Correspondence: Ismail Okan Yildirim, MD, Department of Radiology, Inonu University Faculty of Medicine, Turgut Ozal Medical Center, TR-44280 Malatya, Turkey. (ioyildirim@gmail.com).

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

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