Percutaneous translymphatic thoracic duct embolization for treatment of chylothorax

Abstract

Summary. A modified technique for transabdominal, translymphatic occlusion of the thoracic duct is described. During unilateral lymphangiography an abdominal lymph vessel was punctured with a fine needle under fluoroscopic guidance, and a 4 French access to the lymph system established. The thoracic duct was successfully embolized with coils and tissue adhesive in a patient with postoperative high output chylothorax. Chylous drainage immediately decreased after the intervention, the intercostal drain could be removed after seven days. Long term follow up over a ten months period confirmed the clinical success; the patient is still free of pleural effusions.Key words: Chylothorax ± Lymphatic system ± Intervention ± Embolization ± Treatment Pekutan-translymphatische Embolisierung der Ductus Thoracicus als Therapie für Chylothorax. Es wird eine modifizierte Technik zum transabdominellen, translymphatischen Verschluss des Ductus thoracicus vorgestellt: Während unilateralter Lymphangiographie wird ein abdominelles Lymphgefäû unter Durchleuchtungskontrolle punktiert und über einen Füh-rungsdraht koaxial eine F4-Schleuse platziert. Bei einem Patienten mit therapieresistentem postoperativen Chylothorax wurde über diesen Zugang der Ductus thoracicus distal der Verletzungsstelle mit Spiralen und Gewebekleber verschlossen. Die über eine Thoraxdrainage drainierte Chylusmenge fiel sofort nach der Intervention ab und versiegte im Verlauf, so dass die Thoraxdrainage nach sieben Tagen gezogen werden konnte. Der Patient ist mittlerweile zehn Monate frei von Pleuralerguss bzw. Chylothorax, so dass die komplikationslose Intervention auch langfristig erfolgreich war.

Thoracic Duct Embolization for Chylous Leaks

“…13,18 Since then, several case reports and retrospective case series have been published. 14,[19][20][21]…”

Percutaneous treatment of thoracic duct injuries

“…The first report describing percutaneous treatment of chyle leak with catheterization of the cisterna chyli in humans was published by Cope [6] in 1998. In the following years, his experience was replicated by other authors [2,3,5,18].…”

“…We found five case series and three case reports evaluating percutaneous treatment for chyle leak [2][3][4][5][6][7][8][9]. Three of the case series were from the same institution [6][7][8], and only the most comprehensive paper was included in our analysis [7].…”

Percutaneous embolization of thoracic duct injury post-esophagectomy should be considered initial treatment for chylothorax before proceeding with open re-exploration

“…4 Since that publication, several authors have reported their results with this technique. [15][16][17][18][19] The technique has been extended to pediatric patients who have been successfully treated for chylothorax post open heart operations in the first 6 months of life. 20 Most recently, traumatic lacerations of the cysterna chyli have been successfully treated using multiple embolizations.…”