Abstract No. 88 Lymphatic Embolization for Symptomatic Pelvic Lymphatic Leaks Following Genitourinary Surgery: Experiences at a Single Quaternary Care Center

To investigate the efficacy and safety of lymphatic embolization for the management of pelvic lymphatic leaks following genitourinary surgery. Adult patients who had undergone genitourinary surgery complicated by pelvic lymphatic leaks (LL) resulting in pelvic lymphoceles or ascites who were treated with lymphatic embolization (LE) were retrospectively identified and reviewed. Seven patients (6 males, 1 female; average age: 59.9 years; range: 18-77 years) underwent a total of 10 interventions. Index surgeries included renal transplantation, prostatectomy, cystectomy, and nephroureterectomy. Leaks presented as lymphocele (n = 4) or ascites (n = 3). Procedures consisted of uni- or bilateral inguinal intranodal lymphangiography to identify LLs. After identification, upstream lymphatic targets were accessed under fluoroscopy and glue embolization was performed. LLs were identified in 10/10 procedures. The average number of targets embolized per intervention was 3.11 (range: 1-6). Two patients required a total of five interventions. Drainage catheter daily output before and after LE, and time to drain removal was recorded, when available. Follow up was available for 3 to 31 months post-procedure and included abdominopelvic ultrasound or CT imaging in all patients. Complications were recorded and classified according to the Society of Interventional Radiology adverse event classification system. Technical success, defined as glue embolization, was achieved in 9/10 interventions. Clinical success, defined as improvement of ascites allowing for drain removal or stability or resolution of lymphocele volume was achieved in 6/7 (85.7%) patients. Average daily drain output for interventions (n=4) in which output was recorded pre-LE and post-LE was 901 cc/day (range: 601-1261 cc/day) and 607 cc/day (range: 15-1261 cc/day), respectively. Average daily output of the clinically successful group (n = 3) was 1002 cc/day pre-LE and 389 cc/day post-LE. Average time to drain removal was 10.25 days (range: 2-21 days). Two complications were identified: erythema and blistering near an inguinal access site and hip pain, which were self-limited (category A) and lymphatic vessel rupture requiring re-embolization (category B). Lymphatic embolization is safe and effective for the management of iatrogenic lymphatic leaks following genitourinary surgeries. Repeat embolization may be necessary in some cases. Studies investigating predictors of clinical failure following initial technical success would be beneficial.