Chapter 52 - Lymphatic complications Flashcards
Causes of lymphatic insufficiency after bypass
1) increased production of interstitial fluid
2) transport capacity of lymphatic system reduced due to injury in surgery
Treatment of post-op edema
1) elevation
2) bed rest
3) correct cardiac failure
4) compression
5) stockings
drugs don’t help
Rate of lymphatic fistula
0.8-6.4%
Management of lymphatic fistula
1) wound care
2) systemic antibiotic
3) bed rest + elevation
4) vac therapy
Usual lymphatic leakage days to stop
7-12 days with conservative management
Surgical management of lymphatic fistula
30-60 min pre-op inject 5 ml isosulfan blue (Lymphazurin) into 1st and 3rd interdigit space
compression pump to increase lymphatic and venous drainage
oversew blue dye leakage
injection of fibrin glue
Lymphocele vs seroma
Lymphocele has well-localized connection with one or more lymphatic channels
shows up readily on lymphoscintigraphy
Management of lymphocele
small = observe
large near graft = excise
isosulfan blue injection
ligate/oversew lymphatic pedicle
muscle flap coverage to form new lymphatic outflow drainage
Retroperitoneal lymphocele after aortic recon rate
0.1%
often associated with groin lymphocele
Lymphocele after donated kidney
0.6-18%
Pre-op treating patient for identifying chyle
24 oz whipping cream 4 hour before surgery
Location of cisterna chyle
sits behind aorta near SMA origin
L2 between IVC and Ao
50% do not have a well-defined one
Percutaneous sclerotherapy for lymphocele
1) talcum
2) bleomycin
3) doxycycline
4) povidone-iodine
5) fibrin sealant
6) absolute alcohol
Symptoms of chylous ascites
1) progressive abdominal pain
2) dyspnea
3) nausea
4) malnourishment
5) lymphopenia and anemia
Mortality with chylous ascites after open aaa
17%
Management of chylous ascites
1) medium chain TG diet - decrease chyle formation
2) complete bowel rest and TPN
3) paracentesis
4) peritoneovenous shunt - may cause sepsis
5) surgical correction
Surgery for chylous ascites
ligate mesenteric and para-aortic lymphatic leakage
Formation of the cisterna chyli
1) right and left lumbar
2) mesenteric lymphatic trunks
Rate of chylothorax after cardiothoracic surgery
0.2-1%
Chylous fluid in lab
1) creamy layer
2) no odor
3) specific gravity > 1.012
4) TG level > 1.24 mM
Management of chylothorax
1) conservative with drain
2) open repair of chylous leak
3) pleurodesis
4) parietal pleurectomy
5) VATS
Indication to do VATS in chylothorax
1) high output fistula > 1000 ml/24 hr
2) 200 ml/24 hr for > 1 week
