Abstract No. 613 Interventional radiology management of chylous ascites

Abstract

Unresolving chylous ascites is fatal with up to 90% mortality at one year. Interventional management of chylous ascites is poorly understood and there are no guidelines for management. We retrospectively reviewed patients treated for chylous ascites at our institution to evaluate efficacy and safety of lymphangiography and embolization. This is a retrospective review from January 2010 to August 31, 2019 of 7 patients with chylous ascites (average age 52.5 years, 4 female, 6 post surgical, 1 pancreatitis). All patients underwent inguinal lymph node injection. Adjunctive glue embolization was performed if a leak was identified. Data was collected on cause of chylous ascites, conservative management strategies, technical details and success of the procedure. Seven patients had chylous ascites. Six patients (88%) were treated with total parenteral nutrition; one patient treated with diet. Five patients received octreotide. Conservative care failed in all patients. Six patients had pre procedure lymphoscintigraphy that identified a retroperitoneal leak. Seven patients underwent 12 lymphangiogram procedures; seven were performed our institution. Lymphangiogram identified a leak in five patients (83%). Success was achieved in two (33%) patients treated at our institution after glue embolization following fluoroscopic-guided cannulation of the leaking lymphatic channels and one (17%) patient after lymphangiography alone. Two (33%) patients were successfully treated after one procedure. Three (43%) patients unsuccessfully treated at our institution underwent further treatment at a specialized institution in the U.S; all three patients were successfully treated by retroperitoneal nodal glue injection with one patients also requiring surgery. No postprocedural related complications were noted over 30 days. Lymphangiography and embolization is a safe, effective and minimally invasive method for treating chylous ascites. Lymphangiography successfully identified a leak in 83% of patients and successfully treated 50% of patients at our institution. Complex cases were referred to a specialized institute with an overall success rate of 71% from embolization.