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Thoracic duct embolization

Rajiv N Srinivasa, Jeffrey Forris Beecham Chick, Nishant Patel, Joseph J Gemmete, Ravi N Srinivasa
Postoperative lymphoceles may occur after abdominal or pelvic surgery secondary to disruption of lymphatic channels. First-line therapy includes conservative therapy with medical management and dietary restriction. Despite these measures, some patients may have persistent high-output lymphoceles requiring percutaneous aspiration, drainage, or sclerosis. Rarely, surgical evacuation is required. Management of intrathoracic chyle leak by thoracic duct embolization has been well described. Recently, interstitial (intranodal) lymphatic embolization for the treatment of plastic bronchitis has been performed...
March 15, 2018: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Rajiv N Srinivasa, Jeffrey Forris Beecham Chick, Joseph J Gemmete, Anthony N Hage, Ravi N Srinivasa
INTRODUCTION: To report the technical and clinical success of performing minimally invasive endolymphatic embolization in neonates presenting with a chylothorax or chylous ascites. MATERIALS AND METHODS: 3 neonates, 2 males and 1 female, with a mean age of 28 days (range: 19-39 days) presented with a chylothorax (2) or chylous ascites (1) which was refractory to conservative management. All 3 patients (1 previously reported) underwent intranodal lymphangiography followed by thoracic duct embolization with 1 patient undergoing additional sclerosis of the retroperitoneal abdominal lymphatics...
March 7, 2018: Annals of Vascular Surgery
Masayoshi Yamamoto, Kentaro Yamada, Masahiro Horikawa, Hiroshi Kondo, Hiroshi Oba, Shigeru Furui
PURPOSE: To report embolization of the thoracic duct by direct injection of N-butyl-2-cyanoacrylate (NBCA) glue via a puncture needle. MATERIALS AND METHODS: Two cases of high output chylothorax were successfully treated with direct injection of N-butyl-2-cyanoacrylate (NBCA) glue via a puncture needle. In them, conventional thoracic duct embolization (TDE) was attempted, but the cisterna chyli was absent on intranodal lymphangiography, and probably for this reason catheterization of the thoracic duct was unsuccessful...
February 7, 2018: Cardiovascular and Interventional Radiology
Pyeong Hwa Kim, Jiaywei Tsauo, Ji Hoon Shin
PURPOSE: To perform a systematic review and meta-analysis of published studies to evaluate the efficacy of lymphatic interventions for chylothorax. MATERIALS AND METHODS: The MEDLINE, EMBASE, and Cochrane databases were searched for English-language studies until March 2017 that included patients with chylothorax treated with lymphangiography (LAG), thoracic duct embolization (TDE), or thoracic duct disruption (TDD). Exclusion criteria were as follows: a sample size of less than 10 patients, no extractable data, or data included in subsequent articles or duplicate reports...
December 26, 2017: Journal of Vascular and Interventional Radiology: JVIR
Rajiv N Srinivasa, Jeffrey Forris Beecham Chick, Anthony N Hage, Joseph J Gemmete, Douglas C Murrey, Ravi N Srinivasa
BACKGROUND: To report approach, technical success, safety, and short-term outcomes of thoracic duct stent-graft reconstruction for the treatment of chylothorax. METHODS: Two patients, 1 (50%) male and 1 (50%) female, with mean age of 38 years (range: 16-59 years) underwent endolymphatic thoracic duct stent-graft reconstruction between September 2016 and July 2017. Patients had radiographic left-sided chylothoraces (n = 2) from idiopathic causes (n = 1) and heart transplantation (n = 1)...
December 5, 2017: Annals of Vascular Surgery
Janani S Reisenauer, Carlos A Puig, Chris J Reisenauer, Mark S Allen, Emily Bendel, Stephen D Cassivi, Francis C Nichols, Rob K Shen, Dennis A Wigle, Shanda H Blackmon
BACKGROUND: Postoperative chylothorax can be managed by any or all of observation, parenteral nutrition, surgical duct ligation, pleurodesis, or thoracic duct embolization. The objective of this study was to determine the efficacy of standard therapies, such as surgical duct ligation and observation, compared with newer treatment methods (thoracic duct embolization). METHODS: A prospectively maintained database at a single institution was used to identify and review patients with postoperative chylothorax from 2008 to 2015...
January 2018: Annals of Thoracic Surgery
Ilitch Diaz-Gutierrez, Madhuri Vasudev Rao, Rafael Santiago Andrade
OBJECTIVES: We describe an alternative surgical technique for the treatment of chylothorax in patients who have had failure of or are not candidates for transthoracic ligation or embolization by interventional radiology. METHODS: We describe our experience with laparoscopic ligation of the cisterna chyli in 3 such patients and compare our results with published literature. We used a 5-port approach as for foregut surgery. We retracted the liver, transected the gastrohepatic ligament, and retracted the stomach to the left...
September 30, 2017: Journal of Thoracic and Cardiovascular Surgery
Shuji Kariya, Miyuki Nakatani, Yutaka Ueno, Asami Yoshida, Yasuyuki Ono, Takuji Maruyama, Atsushi Komemushi, Noboru Tanigawa
PURPOSE: To report the feasibility and findings of transvenous retrograde thoracic duct cannulation. MATERIALS AND METHODS: The subjects were 13 patients who had undergone retrograde transvenous thoracic ductography. Despite conservative treatment, all required drainage for chylothorax, chylous ascites, or a chylous pericardial effusion. Lymphangiography was performed, and the junction of the thoracic duct with the vein was identified. A microcatheter was inserted into the thoracic duct retrogradely via the junction with the vein...
October 24, 2017: Cardiovascular and Interventional Radiology
Govind B Chavhan, Joao G Amaral, Michael Temple, Maxim Itkin
The lymphatic system, an important component of the circulatory system with essential physiologic functions, can be affected by various disease processes. There has been a delay in the development of effective imaging methods for the lymphatic system due to its small size, which limits visualization as well as introduction of contrast material. Traditionally, the lymphatic system has been imaged by injecting contrast material or radiotracers into the feet or hands. This is not sufficient for assessment of the central conducting lymphatics (CCLs) (such as the thoracic duct or the cisterna chyli)...
October 2017: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Bill S Majdalany, Wael A Saad, Jeffrey Forris Beecham Chick, Minhaj S Khaja, Kyle J Cooper, Ravi N Srinivasa
BACKGROUND: Interventional radiology treatment of chylothorax is well described in adults, with high technical and clinical success that decreases patient morbidity and mortality. However there is limited experience in children. OBJECTIVE: To report the technical and clinical success of lymphangiography, thoracic duct embolization and thoracic duct disruption in the pediatric population. MATERIALS AND METHODS: We studied 11 pediatric patients (7 boys, 4 girls; median weight 6...
September 28, 2017: Pediatric Radiology
Maxim Itkin
Lymphatic malformations (LMs; especially those involving the central conducting lymphatic channels) are characterized by dysplastic and incompetent lymphatic channels in multiple tissues and organs. The major cause of mortality and morbidity in patients with thoracic LM is deterioration of pulmonary function due to chronic chylous effusions and progressive interstitial lung disease. The etiology of these pulmonary processes is unknown, although lymphatic involvement is certain. Understanding of the changes in the lymphatic anatomy in patients with LM has been hindered by difficulty of imaging of the lymphatic system...
September 2017: Seminars in Interventional Radiology
Eric M DePopas, Livia A Veress, Farres Ahmed, Christopher M Rausch, Aparna Annam, Rajan Gupta
Plastic bronchitis is a life-threatening condition of airway obstructive cast formation. This pediatric case series from a high altitude center details the course of three patients after percutaneous thoracic duct interventions for refractory plastic bronchitis, with a follow-up interval of 3.5 years. In two patients, where cisterna chyli maceration (patients 2) or thoracic duct embolization (patient 3) was performed, a sustained clinical improvement is shown, with no subsequent cast recurrence. In patient 1, cisterna chyli maceration resulted in partial improvement...
November 2017: Pediatric Pulmonology
Tomohito Saito, Shuji Kariya, Tomohiro Murakawa
Postoperative chylothorax is a relatively rare but potentially fatal complication caused by iatrogenic injury to thoracic duct system, with an incidence ranging from 2 to 4% after major lung surgery or esophagectomy. The pathophysiologic features of chylothorax include dehydration, loss of nutrients and immunological components. Intraopreative prevention is the first step for the management, and treatment options include conservative therapy, percutaneous intervention, and redo-operation. Although the treatment algorithm has not been standardized, chylothorax which is refractory to conservative treatment, or that with high output greater than 1,000 ml/day should be treated aggressively with thoracic duct embolization or redo-operation in a timely fashion...
July 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Bülent Arslan, Abdulrahman Masrani, Jordan Cameron Tasse, Kerstin Stenson, Ülkü Cenk Turba
Lymphatic leak is a well-documented complication following neck dissection surgeries. When conservative methods fail to control the leak, thoracic duct embolization becomes an option. Transabdominal access is the standard for this procedure; however, it is not always feasible. We discuss a technique of selective lymphatic vessel embolization utilizing retrograde transvenous access.
September 2017: Diagnostic and Interventional Radiology: Official Journal of the Turkish Society of Radiology
Christopher M Hart, Kelly R Haisley, Christian Lanciault, James P Dolan
A 55 year old male smoker presented with clinical T3N0 esophageal adenocarcinoma of the GE junction. He completed neoadjuvant chemoradiotherapy with carboplatin/paclitaxel and 5040cGy of radiation. He had limited clinical response on restaging but no evidence of metastatic disease and completed a minimally invasive three field esophagectomy. This was complicated by a chyle leak requiring thoracic duct embolization from which he recovered well. Surgical pathology showed no apparent nodal disease or metastases but a poorly differentiated primary tumor with signet-cell features...
April 2017: Seminars in Thoracic and Cardiovascular Surgery
Jill J Savla, Maxim Itkin, Joseph W Rossano, Yoav Dori
BACKGROUND: Post-operative chylothorax in patients with congenital heart disease is a challenging problem with substantial morbidity and mortality. Currently, the etiology of chylothorax is poorly understood and treatment options are limited. OBJECTIVES: This study aimed to report lymphatic imaging findings, determine the mechanism of chylothorax after cardiac surgery, and analyze the outcomes of lymphatic embolization. METHODS: We conducted a retrospective review of 25 patients with congenital heart disease and post-operative chylothorax who presented for lymphatic imaging and intervention between July 2012 and August 2016...
May 16, 2017: Journal of the American College of Cardiology
Ruud S Kootte, Joost D E Haeck, Krijn P van Lienden, Wim J P van Boven, Allard C van der Wal, Hans H de Boer
A 68-year-old woman, previously treated with embolization of the thoracic duct with Lipiodol (an ethiodized oil injection) and cyanoacrylate glue (a topical tissue adhesive), was admitted with an asymptomatic mass in the inferior vena cava (IVC) and right atrium. The mass was surgically removed, and pathologic analysis revealed a Lipiodol-containing thrombus. To our knowledge, this is the first clinicopathologic report of Lipiodol-induced thrombus presenting as an intracavitary mass.
March 2017: Annals of Thoracic Surgery
Michael Yannes, Donghoon Shin, Kevin McCluskey, Rakesh Varma, Ernesto Santos
PURPOSE: To evaluate clinical success and time to resolution of intranodal lymphangiography (INL) alone or with thoracic duct embolization (TDE) or thoracic duct disruption (TDD) based on initial effusion volume for postsurgical chylothorax. MATERIALS AND METHODS: Retrospective review was performed of 57 patients (mean age 63 y; 65% male) undergoing INL alone or in conjunction with other percutaneous techniques for postsurgical chylous effusions. INL alone was performed when chylothorax output was ≤ 500 mL/d and no leak was identified during fluoroscopy...
May 2017: Journal of Vascular and Interventional Radiology: JVIR
Maxim Itkin
Pulmonary lymphatic diseases have been recognized for many years and have been referred as pulmonary lymphangiectasia, pulmonary lymphangiomatosis, plastic bronchitis, and idiopathic chylothorax or chylopericardium. The lymphatic etiology of these conditions has been determined by detection of cystic lymphatic structures on biopsy or postmortem examination. Development of new imaging techniques such as dynamic contrast-enhanced magnetic resonance lymphangiography has allowed better understanding of pathophysiology of these conditions...
December 2016: Techniques in Vascular and Interventional Radiology
Jinoo Kim, Je Hwan Won
Chylous ascites occurs as a result of lymphatic leakage, which contains high concentration of triglycerides. The leakage is caused by various benign or malignant etiologies ranging from congenital lymphatic abnormality to trauma. Lymphangiography has been shown to be effective in the diagnosis of lymphatic leakage and has also been reported to have therapeutic outcome. The development of intranodal technique for lymphangiography has recently made the procedure more widespread. As an adjunctive procedure, percutaneous embolization may be performed which involves use of embolic agents such as N-butyl cyanoacrylate and coil to occlude the leak...
December 2016: Techniques in Vascular and Interventional Radiology
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