Diagnostic and therapeutic utility of ethiodized oil-based lymphangiography in pelvic and groin lymphatic leaks

Abstract Background Pelvic and groin lymphoceles and lymphatic leaks remain challenging postsurgical complications. Ethiodized-oil (lipiodol) lymphangiography has been increasingly utilized as a combined diagnostic and therapeutic modality, but published experience with lipiodol-only management in this setting is limited. While transnodal glue embolization is well established, evidence on its long-term outcomes and safety profile remains sparse, with particular concerns regarding the potential risk of lymphedema. These gaps highlight the need for further evaluation of lymphangiography alone as a minimally invasive treatment option. Materials and methods This retrospective study included patients who underwent lymphangiography between January 2019 and March 2023 for persistent symptomatic pelvic lymphoceles or groin lymphatic leaks. Imaging findings, drain output, prior interventions, and clinical outcomes were reviewed. Technical success was defined as adequate visualization of the targeted lymphatic vessels. Clinical success was defined as resolution or minimal residual leak without need for further treatment. Results Ten patients (5 males, median age, 69 years) underwent lymphangiography for pelvic lymphoceles ( n = 7) or groin lymphatic leaks ( n = 3). The median interval from surgery to INL was 67.5 days (range, 12–108). Three patients had previously undergone surgical interventions, and four patients had undergone sclerotherapy without clinical improvement before INL was performed. Technical success was achieved in all patients (100%) with identification of lymphatic leak in all patients. Clinical success was achieved in 7 patients (70%) following lymphangiography alone, with a median time to resolution of 5.5 days (range, 5–12 days) and no immediate adverse events. Conclusions Lymphangiography using ethiodized oil contrast is a safe, and potentially effective minimally invasive treatment for pelvic and groin lymphatic leaks. These findings support a stepwise management approach, using lymphangiography as a first-line intervention before escalating to intranodal glue embolization.