Journal of Clinical Case Reports

Successful Treatment With Lymphovenous Anastomosis for Lower Extremity Edema Secondary to Lipiodol Lymphangiography

Abstract

Shoichi Sasaki, Yasutoshi Suzuki, Kohei Umekawa, Takashi Kurabayashi and Hirotaka Asato

Background: Chylothorax is one of the complications after thoracic surgery and treated by conservative or surgical means. Lipiodol lymphangiography is one of the options and it causes obliteration of chylous leak by inflammatory manner. In this article, we describe a case of lymphedema of the bilateral lower extremities occurs after lipiodol lymphangiography and it is treated successfully by lymphovenous anastomosis. Case presentation: A 67-year-old man presented with refractory chylothorax after subtotal esophagectomy and thoracic lymph node dissection. His chylothorax developed 4-month later of subtotal esophagectomy and was refractory to the conservative treatment (i.e. tube thoracostomy). He was referred to our department to treat chylothorax. We chose lipiodol lymphangiography as the treatment. Lymphatic duct of left foot was detected with indocyanine green and exposed to inject lipiodol into lymphatic duct directly. Chylothorax improved immediately after lipiodol lymphangiography and his edema of right lower extremity emerged 22-month later of lipiodol lymphangiography. We considered that his lower extremity edema was caused by lipiodol lymphangiography and performed lymphovenous anastomosis. Lymphovenous anastomosis was performed at the proximal of right thigh and the dorsum of the foot. At six-month later of lymphovenous anastomosis, we revealed that his right lower extremity had become thinner significantly, nevertheless laterality remained. Conclusion: To our best knowledge, this is the first report of lymphedema of the bilateral lower extremities after lipiodol lymphangiography for chylothorax. Lymphovenous anastomosis is a treatment option for such condition.