A Novel Technique in The Treatment of Lymphoceles After Renal Transplantation: C-arm Cone Beam CT-Guided Percutaneous Embolization of Lymphatic Leakage Following Lymphangiography

Background We aimed to evaluate the efficacy of percutaneous embolization following lymphangiography using C-arm cone-beam computed tomography (CBCT) performed at the site of lymphatic leakage in patients with postrenal transplant lymphocele. Methods Between July 2014 and August 2017, 13 patients not responding to percutaneous ethanol sclerotherapy and conservative treatment for recurrent lymphocele following renal transplant were included. The mean age of the patients was 56.38 ± 9.91 (range: 36 to 70) years and it comprised 9 men and 4 women. All patients underwent intranodal lymphangiography. C-arm CBCT-guided percutaneous embolization was performed in patients with confirmed lymphatic leakage. Patients who had no lymphatic leakage underwent drainage with fibrin glue injection. Results Lymphatic leakage was observed in 9 patients following lymphangiography and they underwent CBCT-guided percutaneous N-butyl-2-cyanoacrylate (NBCA) embolization. The volume of lymphatic drainage reduced to less than 10 cc in 8 patients. One patient who was not responding to embolization was treated surgically, after percutaneous drainage and fibrin glue injection. Lymphatic leakage wasn't observed in 4 patients following lymphangiography. Of these, 3 patients showed a reduction in the amount of ymphatic drainage following the lymphangiography. All 4 patients underwent percutaneous drainage and fibrin glue injection. One patient didn't respond to the treatment and was treated surgically. Pre and post lymphangiography and embolization, the volume of lymphatic drainage was 113,07±21,75 ml, and 53,84±30,96 ml respectively, and statistically significant decrease was detected. (p

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