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Thoracic duct embolization in treating postoperative chylothorax: does bail-out retrograde access improve outcomes?

  • Interventional
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European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate clinical outcomes of thoracic duct embolization (TDE) for the management of postoperative chylothorax with the aid of the bail-out retrograde approach for thoracic duct cannulation (TDC).

Materials and methods

Forty-five patients with postoperative chylothorax underwent Lipiodol lymphangiography (LLG) between February 2016 and November 2019. If targetable central lymphatic vessels were identified in LLG, TDC, a prerequisite for TDE, was attempted. While the conventional antegrade transabdominal approach was the standard TDC method, the retrograde approach was applied as a bail-out method. Embolization, the last step of TDE, was performed after confirming leakages in the trans-TDC catheter lymphangiography. Technical and clinical success rates were determined retrospectively.

Results

TDC was attempted in 40 among 45 patients based on LLG findings. The technical success rate of TDC with the conventional antegrade approach was 78% (31/40). In addition, six more patients were cannulated using the bail-out retrograde approach, which raised the technical success rate to 93% (37/40). While 35 patients underwent embolization (TDE group), ten patients did not (non-TDE group) for the following reasons: (1) lack of targetable lymphatics for TDC in LLG (n = 5), (2) technical failure of TDC (n = 3), and (3) lack of discernible leakages in the transcatheter lymphangiography (n = 2). The clinical success of the TDE group was 89% (31/35), compared with 50% (5/10) of the non-TDE group. One major procedure-related complication was bile peritonitis caused by the needle passage of the distended gallbladder.

Conclusions

Bail-out retrograde approach for TDC could improve the overall technical success of TDC significantly.

Key Points

Bail-out retrograde thoracic duct access may improve the overall technical success of thoracic duct access, thus improving the clinical success of thoracic duct embolization.

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Abbreviations

LLG:

Lipiodol lymphangiography

PACS:

Picture archiving and communication systems

TDC:

Thoracic duct cannulation

TDE:

Thoracic duct embolization

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Acknowledgements

This research was supported by the Basic Science Research Program of the National Research Foundation of Korea (Grant No. NRF-2018R1C1B6007875), funded by the Ministry of Science, ICT and Future Planning.

Funding

This study has received funding by the Ministry of Science, ICT and Future Planning of Korea.

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Correspondence to Saebeom Hur.

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The scientific guarantor of this publication is Saebeom Hur.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board (IRB number: 1711-080-900).

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Institutional Review Board approval was obtained.

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• observational

• performed at one institution

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Jun, H., Hur, S., Jeong, Y.S. et al. Thoracic duct embolization in treating postoperative chylothorax: does bail-out retrograde access improve outcomes?. Eur Radiol 32, 377–383 (2022). https://doi.org/10.1007/s00330-021-08145-9

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  • DOI: https://doi.org/10.1007/s00330-021-08145-9

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