Endolymphatic Balloon-Occluded Retrograde Abdominal Lymphangiography (BORAL) and Embolization (BORALE) for the Diagnosis and Treatment of Chylous Ascites: Approach, Technical Success, and Clinical Outcomes

Abstract

To describe endolymphatic balloon-occluded retrograde abdominal lymphangiography (BORAL) and embolization (BORALE) for diagnosis and treatment of chylous ascites in patients with previously unidentifiable leakage site or failed lymphatic embolization. Two (66%) men and 1 (33%) woman with mean age of 52years (range: 14-79years) presented with chylous ascites and underwent BORAL or BORALE between March 2016 and February 2017. Patients presented with chylous ascites (n=3) and with renal cell carcinoma after left nephrectomy and lymph node dissection (n=1), metastatic Merkel cell carcinoma after left nephrectomy and adrenalectomy (n=1), and heart transplantation after failed Fontan procedure (n=1). Pelvic lymphangiography technical successes, complications, radiation dose, contrast volume, clinical response, and follow-up were recorded. Pelvic lymphangiography and BORAL were technically successful in 3 (100%) patients. BORALE was attempted in 2 (66%) patients and was technically successful in both patients (100%). No minor or major complications occurred. Mean radiation dose was 1,037mGy (range: 391-2,264mGy). Mean contrast was 83mL (range: 25-150mL). Mean blood loss was 15mL (range: 5-30mL). Chylous ascites resolved in all 3 (100%) patients. BORAL and BORALE provide a rational and effective approach for the diagnosis and treatment of patients with chylous ascites and previously unidentifiable leakage site or failed lymphatic embolization.