Percutaneous Transvenous Embolization of the Thoracic Duct in the Treatment of Chylothorax in Two Patients

CT-guided Injection of N-butyl Cyanoacrylate Glue for Treatment of Chylous Leak after Aorto-mesenteric Bypass

“…Since Cope first described cannulation of the cisterna chyle and embolization with fibered platinum microcoils, interventional radiologists have developed additional minimally invasive techniques for managing lymphatic leaks. These include needle disruption of lymphatic tracts and transvenous retrograde access of the thoracic duct for embolization [6,7].…”

Lymphatic Imaging: Current Noninvasive and Invasive Techniques

“…1,37 Currently, it is most frequently accessed via inguinal lymph nodes (intranodal lymphangiography), although retrograde transvenous access of the thoracic duct, direct percutaneous retrograde access of the cervical portion of the thoracic duct, transhepatic access of intrahepatic lymphatic vessels, and mesenteric lymph node access have also been described. [4][5][6][7][8][9][10][11][12][13][14][15][16]…”

“…It was not until intranodal lymphangiography was described in pediatric 4 and adult 5 patients in 2011 and 2012, respectively, that invasive lymphangiography gained popularity as a precursor for lymphatic interventions. In addition to intranodal lymphangiography, transvenous retrograde, [6][7][8][9] percutaneous direct retrograde, [10][11][12] transhepatic, [13][14][15] and mesenteric lymphangiography 16 have also been described in case reports or series. These different invasive lymphangiography approaches have, in turn, enabled the treatment of lymphatic leakages at locations other than the thorax.…”

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

“…22 The TD is typically approached in an antegrade fashion after the cysterna chyli identification on lymphangiogram, although retrograde cannulation from the subclavian vein can be used as alternative access for neck or upper TD disruption. [22][23][24] …”