Abstract No. 612 Impact of number of inflow lymphatics on efficacy of lymphangiography and embolization of postoperative groin and pelvic lymphoceles

To evaluate the impact of the number of inflow lymphatics and outcomes of lymphangiography and glue embolization of postoperative groin and pelvic lymphoceles. A single-center retrospective review of 14 consecutive patients (8 males, 6 females) over a 1-year period who underwent lymphangiography with possible embolization for the management of postoperative groin and pelvic lymphoceles was performed. Lymphangiography was performed by lipiodol injection of lymph nodes to assess the presence and number of disrupted lymphatic ducts. If extravasation into the lymphocele was noted, glue embolization was performed using an N butyl cyanoacrylate (NBCA) and lipiodol mixture with a 1:3-1:5 ratio. Daily drain output before and after procedure and days until drain removal post procedure were evaluated. Statistical analysis was performed using a one-tailed t-test. Lymphangiography revealed disruption of a single inflow lymphatic in 4/14 (29%) patients and multiple inflow lymphatics in 8/14 (57%) patients, all of which were subsequently embolized. In 2/14 (14%) patients no inflow lymphatic was identified and embolization was not performed. In the 4 patients with a single inflow lymphatic, the mean daily drain output decreased from 180 ± 48 mL/d to 65 ± 62 mL/d after embolization (P = 0.02); the mean time to removal was 17 ± 13 days. In the 8 patients with multiple inflow lymphatics, the mean daily drain output decreased from 510 ± 130 mL/d to 180 ± 81 mL/d after embolization (P = 0.045); the mean time to removal was 30 ± 11 days. The mean daily drain output in the 2 patients that did not have inflow lymphatics decreased from 250 mL/d to 10 mL/d after lymphangiography; the mean time to removal was 10 days. No procedure-related complications were identified. Lymphatic intervention with lymphangiogram and embolization was technically feasible in treating postoperative lymphoceles. For all groups, lymphangiogram with/without embolization was associated with improved drain output and subsequent drain removal postprocedurally, but multiple inflow lymphatics were associated with longer time to drain removal and higher daily drain output post procedure.