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Table 2 The four major types of therapeutical interventions based on the iodized oil-based LAG

From: The roles of iodized oil-based lymphangiography and post-lymphangiographic computed tomography for specific lymphatic intervention planning in patients with postoperative lymphatic fistula: a literature review and case series

Interventions Basic indications Introductions of the procedure
DLE/DLS (Hur et al. 2016, Kim et al. 2019) Identification of confined extravasation from the LVs contained by the surrounding tissue, which could also be called “lymphopseudoaneurysm” or lymphocele. The confined extravasation was punctured by using a 21- or 22-gauge needle, or with a drainage catheter. Then, the glue or the sclerosant solution was injected to completely fill and/or flush the confined extravasation.
ALVE (Cope and Kaiser 2002, Boffa et al. 2008, Baek et al. 2016a, Baek et al. 2016b) Identification of the direct upstream and accessible LV that directly extravasated. The upstream LV of the LF was directly puncture by using a 21- or 22-gauge needle. Then, the embolized agents (eg. glue, particles, coils, etc.) were injected through the needle or advanced microcatheter to completely embolize the target LV close to the leakage site.
ALVD/ALVS (Cope and Kaiser 2002, Chen and Itkin 2011, Kortes et al. 2014) Identification of the direct upstream LV that directly extravasated, but the target upstream vessel, that was accessible for the embolization, was very small or multi-branched. In addition, the surrounding area was not close to important blood vessels or nerves. The 21- or 22-gauge needle was advanced as close as possible to the target upstream LVs. Then, repeated probing or injection of the sclerosant solution occurred to destroy the target LVs.
TNE (Hur et al. 2016, Kim et al. 2019) Identification of the site of the contrast extravasation and the closest upstream LN from which efferent LV extravasated a short distance away. The closest upstream LNs of the LF were punctured by using 21- or 22-gauge needle, and then glue was injected along with the lymphatic flow to embolize the leakage at the end.
  1. Abbreviation: DLE/DLS Direct leakage embolization/sclerotherapy, ALVE Afferent lymphatic vessel embolization, ALVD/ALVS Afferent lymphatic vessel disruption/sclerotherapy, TNE Trans-nodal embolization