Cisterna Chyli and Thoracic Duct Glue Embolization

Percutaneous Thoracic Duct-Cistena Chyli Coil and Glue Embolization via Antgrade Sublumbar Cisterna Chyli Access in a Cat with Chylothorax

“…The author believes that direct access to the cisterna chyli and the thoracic duct also allows for more controlled injection of the embolic mixture decreasing the risk of glue embolization into the systemic circulation. This complication has been reported as an a clinically silent finding in a dog [12] and as a fatal consequence of TDE in a cat [11]. Injection of the embolic mixture in a 'pull-back' manner, starting in proximity of the target occlusion site, enables use of higher glue concentrations.…”

“…Interventional thoracic duct embolization has received li le a ention in veterinary literature, although it was described already in 1989 [3]. Detailed description of the technique can be found elsewhere [3,11,12], but briefly, a laparotomy is required to expose and catheterize abdominal efferent A B lymphatics that are subsequently injected with n-butyl cyanoacrylate: ethiodized oil mixture. The embolic material is being pushed into the TD and CC by continued injection from the operator to cause permanent occlusion of the TD and CC as the nBCA polymerizes and solidifies.…”

“…The interventional approach to management of chylothorax offers several theoretical advantages over surgical ligation. Glue embolization could theoretically allow occlusion of smaller thoracic duct tributaries that cannot otherwise be easily visualized [11]. Intraluminal occlusion of the thoracic duct offers the possibility of migration of the embolic to other (initially patent) lymphatic channels once the initial branch has become occluded.…”

“…This translates into shorter polymerization time and likely limiting too cranial migration of the embolic mixture. Some authors [3,11] suggest use of positive pressure ventilation to hinder cranial migration of lymphatic embolus toward the cranial vena cava. This was not required in our patient.…”

“…In human medicine percutaneous lymphatic embolization (LE) with n-butyl cyanoacrylate (nBCA) performed by interventional radiologists is commonly utilized treatment method of chylothorax. Surgical approaches to lymphatic embolization have been described in dogs [3,11]. Use of this technique has been reported as a salvage procedure in two canine idiopathic chylothorax cases that recurred after surgical intervention [12].…”