Table 1.

Patients treated for central lymphatic lesions.

Patient (age in years)	Preoperative condition	MRL	Duration of conservative treatment (months)	Previous intervention/surgery	Surgical access	Surgery	Symani surgical system	Follow-up	Outcome
1 (52) M	Iatrogenic lesion of TD with chylous fistula	None	1.5 months	None due to absent cisterna chyli	Neck	End-to-end anastomosis of TD and EJ	No	5 years	No recurrence of lymph leak
2 (52) F	CCLA with bilateral chylothorax	TD stenosis in the mediastinum with upstream dilatation of the TD	6 months	LA: recanalization impossible	Median laparotomy	Intraabdominal end-to-end anastomosis of TD and LIPV	No	4 years	Complete remission
3 (6 months) F	Bilateral chylothorax, chylaskos anasarca including head and neck and PLE, multiple venous thromboses	Lack of lymphatic drainage of the head, massive intestinal reflux	6 months	Multiple attempts of catheter-based lysis; multiple interventional thrombectomy and stenting	Neck	Antero- and retrograde end-to-end anastomosis of TD and collateral vein, 1× cervical LVA	No	6 weeks	PLE remission, improvement of anasarca and chylothorax; death during thrombolysis 6 weeks postop
4 (19) F	CCLA with recurrent bilateral chylothorax	Dysplastic TD and aberrant lymphatic drainage along the abdominal wall and chest	5 years	None	Chest wall	1× LVA and MLL lateral chest wall	No	1 year	Persistence of chlyothorax
5 (21) F	CCLA with anasarca and bilateral chylothorax	Occlusion of TD at the subclavian angle	10 years	None	Neck	3× LVA at the neck	No	10 months	Regression of symptoms with improvement of anasarca and chylothorax
6 (47) F	Lower extremity edema, abdominal pain and reduced physical capacity	Aneurysmal dilatation of the left paramedian lymphatic duct and dilated lymphatic cisterns along the iliac lymphatic pathways	NA	LA: embolization	Median laparotomy	Intraabdominal end-to-side anastomosis of left OV with lymphatic cyst	Yes	7 months	Regression of symptoms; MRL proved drainage from the aneurysmal dilatation into the ovarian vein
7 (19) F	PLE, plastic bronchitis and lower extremity edema after Fontan surgery	Abruption of TD below the diaphragm, hepato-eneral lymphatic reflux	NA	LA: recanalization	Median laparotomy	Intraabdominal end-to-end anastomosis of TD to right OV	No	7 months	Regression of lower extremity edema
8 (10) M	CCLA with bilateral chylothorax	TD abruption, thoracic lymphatic malformation on the right and lymphatic reflux on the left	2 months	LA: embolization	Median laparotomy	LVA between subdiaphragmal lymph vessel and omental vein; MLL	Yes	5 months	Persistence of chylothorax; Additional interventional embolization
9 (60) F	CCLA with bilateral chylothorax and lower extremity lymphedema	TD not detectable, abruption of retroperitoneal lymphatic pathways at the level of lumbar vertebra 2	30 years (for lower extremity lymphedema)	None	Median laparotomy	Intraabdominal end-to end anastomosis of TD and right GEV, para-aortal and iliac LVA on the left	Yes	3 months	Regression of chylothorax
10 (17) F	CCLA with bilateral chylothorax and chylopericardium	atresia of the TD at the cervical angle	4 months	LA: embolization	Right-sided thoraco-tomy	End-to-end anastomosis of TD and AV; MLL	Yes	2 months	Partial regression of symptoms with increased physical fitness
11 (8 months) M	Bilateral chylothorax	TD stenosis at the level of the angulus venosus sinister, multiple venous thrombosis	8 months	LA: recanalization	Neck	End-to-end anastomosis of TD and branch of the left EJ	Yes	1 months	Reduction of chylothorax, intermittend clamping of drains

CCLA, central conducting lymphatic anomaly; TD, thoracic duct; AV, azygous vein; EJ, external jugular vein; OV, ovarian vein; GEV, gastroepiploic vein; LA, conventional lymphangiography; PLE, protein losing enteropathy; LM, lymphatic malformation; LIPV, left inferior phrenic vein; MRL, MR Lymphangiography.