[Transpedal x-ray lymphangiography and treatment of peripheral lymphatic leakage].

Abstract

Background: Conventional x‑ray transpedal lymphangiography enables the diagnosis of a variety of lymphatic diseases through detailed visualization of the lymphatic vessels, in particular those of the lower extremities. Today, it is employed primarily to visualize peripheral lymphatic leakage such as lymphoceles. Its application in lymphoma, lymph node metastases or lymphedema nowadays-with rare exceptions-is only of historical interest.

Objective: To present the basic technical principles of transpedal lymphangiography and the interventional treatment options for peripheral lymphatic leakage.

Results: Transpedal x‑ray lymphangiography has a technical success rate of 75-100% when performed by an experienced interventionalist. Pathological findings are visualized in 58-95% of cases. Additionally, a therapeutic effect on postsurgical lymphatic leakage can be expected in about 50% of patients. Additional interventional procedures such as sclerotherapy and lymph vessel embolization are available for the treatment of peripheral lymphatic leaks, whereby the clinical success rates reach 80-100%. Complications are generally rare.

Conclusion: Transpedal x‑ray lymphangiography is a safe and effective procedure for visualizing lymph vessel anatomy. In patients with peripheral lymphatic leaks and consecutive fistulas and/or lymphoceles, lymphangiography as well as percutaneous sclerotherapy or embolization are successful and increasingly used treatment alternatives to surgery.