Chylous complications of various severity and manifestations within diverse compartments in reconstructive vascular surgery #) #) The manuscript is dedicated to Prof. Dr. Z. Halloul
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Introduction: Chylous complications, which also occur in the profile of vascularsurgical interventions with considerable frequency, are challenging with regard to their adequate management. Aim & method: Short compact overview on epidemiological, classifying, symptomatic, diagnostics and therapeutic aspects of chylous complications in vascular surgery, based on •own clinical experiences, •current selection of relevant scientific references, and •representative case reports from clinical practice. Results (complex patient- & clinical finding-associated aspects): •Basic treatment of lymphedema / postreconstructive edema comprises a complex physical therapy to improve edematous swelling, which needs to be usually performed over years. •In case of lymphocele, a wait-and-see strategy can be initially pursued to observe spontaneous clinical course. If the lymphocele and its clinical complaints persist, puncture, placement of drainage or temporary instillation of doxycyclin or ethanol can be attempted. •In case of lymphatic fistula, vacuum-assisted closure dressing, radiation and selective ligation of lymphatic vessels after previous application of methylene blue dye can be used. •Chylascites and chylothorax should be primarily treated – as has been widely established in the meantime – with a consequently conservative approach initially comprising paracentesis / thoracocentesis, protein-enriched and low-fat diet containing middle-chain triglycerides (MCT) or total parenteral nutrition combined with the application of a somatostatin analogue (surgical approach as ultima ratio only aiming at ligation of the lesioned lymphatic vessel – if necessary, including preoperative consumption of cream). Summary: Chylous complications can be primarily treated with conservative measures, which should be exploited using a step-wise approach prior to surgical intervention as ultima ratio. Conclusion: The experienced vascular surgeon should be acquainted with a sufficient, finding-adapted management of chylous complications. This requires a well-experienced clinician and surgeon with great expertise regarding the interdisciplinary setting comprising of interventional radiology, vascular (abdominal) surgery and partially surgical intensive care.
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