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Thoracic duct embolization

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https://www.readbyqxmd.com/read/29132697/treatment-of-postsurgical-chylothorax
#1
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...
November 11, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29129424/laparoscopic-ligation-of-cisterna-chyli-for-refractory-chylothorax-a-case-series-and-review-of-the-literature
#2
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
https://www.readbyqxmd.com/read/29067509/transvenous-retrograde-thoracic-ductography-initial-experience-with-13-consecutive-cases
#3
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
https://www.readbyqxmd.com/read/29019760/mr-lymphangiography-in-children-technique-and-potential-applications
#4
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
https://www.readbyqxmd.com/read/28956103/pediatric-lymphangiography-thoracic-duct-embolization-and-thoracic-duct-disruption-a-single-institution-experience-in-11-children-with-chylothorax
#5
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
https://www.readbyqxmd.com/read/28955119/magnetic-resonance-lymphangiography-and-lymphatic-embolization-in-the-treatment-of-pulmonary-complication-of-lymphatic-malformation
#6
REVIEW
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
https://www.readbyqxmd.com/read/28869334/percutaneous-thoracic-duct-intervention-to-treat-plastic-bronchitis-related-to-fontan-palliation
#7
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
https://www.readbyqxmd.com/read/28790285/-postoperative-chylotholax-intraoperative-prevention-and-postoperative-management
#8
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
https://www.readbyqxmd.com/read/28724508/superselective-retrograde-lymphatic-duct-embolization-for-management-of-postoperative-lymphatic-leak
#9
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
https://www.readbyqxmd.com/read/28683987/node-negative-esophageal-cancer-with-short-interval-isolated-metastasis-to-the-gallbladder-a-case-report
#10
REVIEW
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
https://www.readbyqxmd.com/read/28494978/post-operative-chylothorax-in-patients-with-congenital-heart-disease
#11
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
https://www.readbyqxmd.com/read/28219554/intravascular-lipiodol-presenting-as-an-atrial-mass
#12
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
https://www.readbyqxmd.com/read/28169139/comparative-analysis-of-intranodal-lymphangiography-with-percutaneous-intervention-for-postsurgical-chylous-effusions
#13
COMPARATIVE STUDY
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
https://www.readbyqxmd.com/read/27993326/interventional-treatment-of-pulmonary-lymphatic-anomalies
#14
REVIEW
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
https://www.readbyqxmd.com/read/27993325/percutaneous-treatment-of-chylous-ascites
#15
REVIEW
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
https://www.readbyqxmd.com/read/27993324/nontraumatic-chylothorax-diagnostic-algorithm-and-treatment-options
#16
REVIEW
Gregory Nadolski
Nontraumatic chylothorax is a relatively rare condition in which the intestinal lymph (chyle) leaks into the pleural cavity. Nontraumatic chylothorax is more difficult to treat than the more common traumatic chylothorax because the site of chylous leak may occur in less predictable locations. In the past, patients with nontraumatic chylothoraces were offered traditional fluoroscopically guided lymphangiography and thoracic duct embolization similar to traumatic chylothorax. However, the observation that thoracic duct embolization outcomes for nontraumatic chylothorax differed based on the imaging findings during lymphangiography has led to the development of a treatment algorithm, which incorporates noninvasive diagnostic studies, such as magnetic resonance lymphangiography...
December 2016: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/27993323/lymphangiography-for-thoracic-duct-interventions
#17
REVIEW
Michael S Stecker, Chieh-Min Fan
Lymph leaks resulting in chylous pleural effusions can be life-threatening. Minimally invasive thoracic duct embolization and disruption have been gaining acceptance as first-line treatment for these leaks. This review discusses the techniques for both pedal and intranodal lymphangiography in detail. It also discusses the use of lymphangiography as a means of targeting a retroperitoneal lymphatic to facilitate thoracic duct interventions for chyle leaks. Finally, outcomes and adverse events pertaining to these thoracic duct interventions are discussed...
December 2016: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/27831840/lymphatic-intervention-for-various-types-of-lymphorrhea-access-and-treatment
#18
REVIEW
Masanori Inoue, Seishi Nakatsuka, Hideki Yashiro, Masashi Tamura, Yohsuke Suyama, Jitsuro Tsukada, Nobutake Ito, Sota Oguro, Masahiro Jinzaki
Traumatic lymphorrhea is a rare but potentially life-threatening complication. Postoperative lymphorrhea is the leading cause of traumatic lymphorrhea and can arise anywhere within the lymphatic system. Leaks arising from the aortoiliac region to the thoracic duct (TD) and from hepatic lymphatics can be identified with intranodal lymphangiography and transhepatic lymphangiography, respectively. Therefore, an appropriate lymphangiography technique is essential for identifying the sources of leaks. Chylothorax resulting from damage to the TD can be serious because the TD transports large amounts of lymphatic fluid from the gastrointestinal, hepatic, and aortoiliac regions...
November 2016: Radiographics: a Review Publication of the Radiological Society of North America, Inc
https://www.readbyqxmd.com/read/27743087/embolization-for-thoracic-duct-collateral-leakage-in-high-output-chylothorax-after-thoracic-surgery
#19
Shuji Kariya, Miyuki Nakatani, Rie Yoshida, Yutaka Ueno, Atsushi Komemushi, Noboru Tanigawa
PURPOSE: This 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. METHODS: Data were retrospectively collected from five patients who underwent embolization for thoracic duct collateral leakage in persistent high-output chylothorax after thoracic surgery...
January 2017: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/27599255/diagnosis-and-treatment-of-lymphatic-plastic-bronchitis-in-adults-using-advanced-lymphatic-imaging-and-percutaneous-embolization
#20
Maxim G Itkin, Francis X McCormack, Yoav Dori
RATIONALE: Plastic bronchitis is a condition characterized by expectoration of branching bronchial casts. Although the mechanism of cast formation in adults with plastic bronchitis remains poorly understood, abnormal pulmonary lymphatic flow resulting in molding of congealing lymphatic fluids in the airway has been documented as a cause of the disease in children with congenital heart disease. OBJECTIVES: To use advanced lymphatic imaging techniques, including dynamic contrast-enhanced magnetic resonance (MR) lymphangiography (DCMRL) and intranodal lymphangiography, to investigate the mechanism of cast formation in adult patients with plastic bronchitis, and to evaluate the therapeutic outcome of percutaneous lymphatic embolization for these patients...
October 2016: Annals of the American Thoracic Society
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