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Title: Embolization for Thoracic Duct Collateral Leakage in High-Output Chylothorax After Thoracic Surgery

Abstract

PurposeThis study was designed to investigate thoracic duct collateral leakage and the supply route of lymphatic fluid by lymphangiography and transcatheter thoracic ductography and to evaluate the results of embolization for thoracic duct collateral leakage performed to cut off this supply route.MethodsData were retrospectively collected from five patients who underwent embolization for thoracic duct collateral leakage in persistent high-output chylothorax after thoracic surgery. Extravasation of lipiodol at the ruptured thoracic duct collaterals was confirmed in all patients on lymphangiography. Transcatheter thoracic ductography was used to identify extravasation of iodinated contrast agent and to identify communication between the thoracic duct and leakage site. Thoracic duct embolization (TDE) was performed using the percutaneous transabdominal approach to cut off the supply route using N-butyl cyanoacrylate (NBCA) mixed with lipiodol (1:5–1:20).ResultsClinical success (drainage volume ≤10 mL/kg/day within 7 days after TDE) was achieved in all patients. The collateral routes developed as consequence of surgical thoracic duct ligation. In three patients, NBCA-Lipiodol reached the leakage site through direct communication between the thoracic duct and the ruptured lymphatic duct. In the other two patients, direct communication and extravasation was not detected on thoracic ductography, and NBCA-Lipiodol did not reach the leakage site. However, NBCA-Lipiodol did reach the cisternamore » chyli, lumbar trunks, and some collateral routes via the cisterna chyli or lumbar lymphatics. As a result, leakage was stopped.ConclusionsTDE was effective for the management of leakage of the collaterals in high-output chylothorax after thoracic surgery.« less

Authors:
; ; ; ; ;  [1]
  1. Kansai Medical University, Department of Radiology (Japan)
Publication Date:
OSTI Identifier:
22645357
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 40; Journal Issue: 1; Conference: BSIR 2016: Britisch Society of Interventional Radiology 2016 annual meeting, Manchester (United Kingdom), 15-17 Nov 2016; Other Information: Copyright (c) 2017 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; DESIGN; DRAINAGE; DUCTS; LEAKS; LIPIODOL; LYMPH VESSELS; PATIENTS; RUPTURES; SURGERY; VASCULAR DISEASES

Citation Formats

Kariya, Shuji, E-mail: kariyas@hirakata.kmu.ac.jp, Nakatani, Miyuki, E-mail: nakatanm@hirakata.kmu.ac.jp, Yoshida, Rie, E-mail: yagir@hirakata.kmu.ac.jp, Ueno, Yutaka, E-mail: uenoyut@hirakata.kmu.ac.jp, Komemushi, Atsushi, E-mail: komemush@takii.kmu.ac.jp, and Tanigawa, Noboru, E-mail: tanigano@hirakata.kmu.ac.jp. Embolization for Thoracic Duct Collateral Leakage in High-Output Chylothorax After Thoracic Surgery. United States: N. p., 2017. Web. doi:10.1007/S00270-016-1472-5.
Kariya, Shuji, E-mail: kariyas@hirakata.kmu.ac.jp, Nakatani, Miyuki, E-mail: nakatanm@hirakata.kmu.ac.jp, Yoshida, Rie, E-mail: yagir@hirakata.kmu.ac.jp, Ueno, Yutaka, E-mail: uenoyut@hirakata.kmu.ac.jp, Komemushi, Atsushi, E-mail: komemush@takii.kmu.ac.jp, & Tanigawa, Noboru, E-mail: tanigano@hirakata.kmu.ac.jp. Embolization for Thoracic Duct Collateral Leakage in High-Output Chylothorax After Thoracic Surgery. United States. doi:10.1007/S00270-016-1472-5.
Kariya, Shuji, E-mail: kariyas@hirakata.kmu.ac.jp, Nakatani, Miyuki, E-mail: nakatanm@hirakata.kmu.ac.jp, Yoshida, Rie, E-mail: yagir@hirakata.kmu.ac.jp, Ueno, Yutaka, E-mail: uenoyut@hirakata.kmu.ac.jp, Komemushi, Atsushi, E-mail: komemush@takii.kmu.ac.jp, and Tanigawa, Noboru, E-mail: tanigano@hirakata.kmu.ac.jp. Sun . "Embolization for Thoracic Duct Collateral Leakage in High-Output Chylothorax After Thoracic Surgery". United States. doi:10.1007/S00270-016-1472-5.
@article{osti_22645357,
title = {Embolization for Thoracic Duct Collateral Leakage in High-Output Chylothorax After Thoracic Surgery},
author = {Kariya, Shuji, E-mail: kariyas@hirakata.kmu.ac.jp and Nakatani, Miyuki, E-mail: nakatanm@hirakata.kmu.ac.jp and Yoshida, Rie, E-mail: yagir@hirakata.kmu.ac.jp and Ueno, Yutaka, E-mail: uenoyut@hirakata.kmu.ac.jp and Komemushi, Atsushi, E-mail: komemush@takii.kmu.ac.jp and Tanigawa, Noboru, E-mail: tanigano@hirakata.kmu.ac.jp},
abstractNote = {PurposeThis study was designed to investigate thoracic duct collateral leakage and the supply route of lymphatic fluid by lymphangiography and transcatheter thoracic ductography and to evaluate the results of embolization for thoracic duct collateral leakage performed to cut off this supply route.MethodsData were retrospectively collected from five patients who underwent embolization for thoracic duct collateral leakage in persistent high-output chylothorax after thoracic surgery. Extravasation of lipiodol at the ruptured thoracic duct collaterals was confirmed in all patients on lymphangiography. Transcatheter thoracic ductography was used to identify extravasation of iodinated contrast agent and to identify communication between the thoracic duct and leakage site. Thoracic duct embolization (TDE) was performed using the percutaneous transabdominal approach to cut off the supply route using N-butyl cyanoacrylate (NBCA) mixed with lipiodol (1:5–1:20).ResultsClinical success (drainage volume ≤10 mL/kg/day within 7 days after TDE) was achieved in all patients. The collateral routes developed as consequence of surgical thoracic duct ligation. In three patients, NBCA-Lipiodol reached the leakage site through direct communication between the thoracic duct and the ruptured lymphatic duct. In the other two patients, direct communication and extravasation was not detected on thoracic ductography, and NBCA-Lipiodol did not reach the leakage site. However, NBCA-Lipiodol did reach the cisterna chyli, lumbar trunks, and some collateral routes via the cisterna chyli or lumbar lymphatics. As a result, leakage was stopped.ConclusionsTDE was effective for the management of leakage of the collaterals in high-output chylothorax after thoracic surgery.},
doi = {10.1007/S00270-016-1472-5},
journal = {Cardiovascular and Interventional Radiology},
number = 1,
volume = 40,
place = {United States},
year = {Sun Jan 15 00:00:00 EST 2017},
month = {Sun Jan 15 00:00:00 EST 2017}
}
  • Thoracic duct embolization represents a safe and effective method to treat postsurgical chylothorax. Complications of this procedure are rare despite transabdominal puncture of lymphatic channels for thoracic duct access, and chylous ascites is unreported. Herein, we describe a case of chylous ascites formation after lymphatic puncture and attempted cannulation. Our management approach is also discussed.
  • Chylothorax is an uncommon type of pleural effusion whose etiology may be classified as traumatic or nontraumatic. Low-output chylothoraces usually respond well to conservative management, whereas high-output chylothoraces are more likely to require surgical or interventional treatment. Conservative management focuses on alleviation of symptoms, replacement of fluid and nutrient losses, and reduction of chyle output to facilitate spontaneous healing. Surgical management can be technically difficult due to the high incidence of variant anatomy and the high-risk patient population. Percutaneous treatments have rapidly developed and evolved during the past 14 years to represent a minimally invasive treatment compared with the moremore » invasive nature of surgery. Percutaneous therapies provide a range of treatment options despite difficult or variant anatomy, with a reported high success rate coupled with low morbidity and mortality. This article is a review of etiology, diagnosis, and treatment of chylothorax, with a focus on interventional management techniques.« less
  • Chylothorax carries significant mortality and morbidity. Patients with high-output chylothorax have traditionally been managed by surgical treatment if nonoperative management has proved unsuccessful. Newer, more recent percutaneous techniques used to treat chylothorax are safer and less invasive than surgery. We present three cases that have been successfully managed using these percutaneous techniques.
  • Endoleak is a frequent complication after endovascular repair of aortic rupture. We describe the case of a female patient with traumatic aortic injury, treated with endograft, who developed a type II endoleak through the left subclavian and vertebral arteries. Both arteries originated independently from the aortic arch, and were managed with coil embolization of each vessel. We also report our experience with treating the left vertebral artery by placing a microcatheter through the right vertebral one.