2.3.2 Endovascular Interventions
Expertise of Interventional radiology (IR) and other interventional specialties (ex. cardiology, neurosurgery) is frequently necessary in the multimodal treatment approach of CLA. IR expertise is needed for lymphoscintigraphy and MR lymphangiography. Lymphoscintigraphy provides dynamic information on flow of lymphatic fluid but lacks spatial resolution and anatomic details. MR lymphangiography provides dynamic and anatomical information of the lymphatic vasculature and can also allow for therapeutic intervention. Progressive accumulation of contrast material followed by slow dispersion into the pleural and/or pericardial spaces helps identify the source of effusions. If a specific area of leakage is found, then embolization with ethiodized oil (Lipiodol) injection is a therapeutic option. Sclerotherapy is also a treatment option for macrocystic and microcystic LM. Sclerotherapy is used to reduce size of LM, improve pain, and decrease complications like frequent infections or bleeding into the cysts.