Incidence and Clinical Course of Lower-Limb Lymphedema after Intranodal n-Butyl-2-Cyanoacrylate Embolization for Postoperative Lymphorrhea

Purpose: To evaluate the incidence and clinical course of lower-limb lymphedema following intranodal n-butyl-2-cyanoacrylate (nBCA) embolization of the inguinal lymph nodes for postoperative lymphorrhea. Materials and Methods: This retrospective study included 26 patients (24 men and 2 women; age, 69.5 years) who underwent intranodal nBCA embolization for postoperative lymphorrhea between 2017 and 2023. Under ultrasound (US) guidance, inguinal lymph nodes were punctured, and embolization was performed with nBCA and ethiodized oil at a 2:1 ratio (ethiodized oil:nBCA). The primary approach was to embolize through the initially accessed lymph node when the efferent channel and leakage site were visualized. Clinical success was defined as improvement of lymphorrhea-related symptoms with catheter removal or ≥80% drainage reduction within 21 days. Lower-limb lymphedema was defined as new-onset or worsening of existing edema in 60 days after embolization and categorized as reversible or persistent. Results: Clinical success was achieved in 24 of 26 patients (92.3%), with a median time to resolution of 6 days (range, 2–21 days). Lower-limb lymphedema worsened in 6 patients (23.1%), including 4 reversible and 2 persistent cases. No new-onset lymphedema occurred; all represented exacerbation of pre-existing edema. Both persistent cases involved patients with prior pelvic lymph node dissection. No procedure-related deaths or major complications occurred. Conclusion: Inguinal intranodal nBCA embolization effectively controls postoperative lymphorrhea but may worsen pre-existing lower-limb lymphedema, particularly in patients with prior pelvic lymph node dissection. To minimize nontarget embolization of lower-extremity drainage pathways, lymphatic embolization should be performed as selectively and as close to the leakage site as possible.