Intranodal Lymphangiography and Lymphatic Embolization Treatment for Groin Lymphorrhea: A Preliminary Vietnamese Report

Nguyen Ngoc Cuong,1 Pham Hong Canh,1 Le Tuan Linh,1,2 Nguyen Minh Duc,2– 4 Thieu Thi Tra My,1,2 Le Hoan5 1Diagnostic Imaging and Interventional Radiology Center, Hanoi Medical University Hospital, Ha Noi, Vietnam; 2Department of Radiology, Hanoi Medical University, Ha Noi, Vietnam; 3Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; 4Department of Radiology, Children’s Hospital 2, Ho Chi Minh City, Vietnam; 5Respiratory Medicine Department, Hanoi Medical University Hospital, Hanoi, VietnamCorrespondence: Le HoanRespiratory Medicine Department, Hanoi Medical University Hospital, Hanoi, VietnamTel +84 372286666Email lehoan.hmu@gmail.comPurpose: This article described intranodal lymphangiography and embolization of patients with lymphatic leak post-operation of the groin region for various aetiologies (lymph node resection, femoral artery exposure).Materials and Methods: A retrospective analysis from 2018 to 2020 was performed and twelve consecutive patients underwent intranodal lymphangiography and intranodal lymphatic embolization to treat lymphorrhea or lymphocele post-operation of the groin. All the lymph nodes around the wound were punctured for lymphangiography. If the extravasation was found from the lymph node, the glue N-butyl cyanoacrylate (NBCA) diluted with lipiodol (ratio of 1:4) was injected to occlude the lymphatic vessel laceration.Results: All the lymph nodes around the wound were punctured with the median number of two lymph nodes for each patient (range from one to four lymph nodes); there were three patients with two leakage points. Intranodal lymphatic embolization was performed by glue NBCA diluted 1:4 with lipiodol. Additional treatment includes sclerotherapy (n=5) and percutaneous muscular flap operation (n=1). Clinical successful was achieved in twelve patients (100%) with no major complications. One patient experienced lymphedema which was was treated by compression stockings and rehabilitation therapy.Conclusion: Intranodal lymphangiography and embolization are effective methods to treat iatrogenic lymphatic leak while all the lymph nodes around the wound should be punctured to avoid missing lesions from other lymphatic vessels.Keywords: intranodal lymphangiography, intranodal lymphatic embolization, groin lymphatic leak, lymphorrhe