Lymphatic Interventional Treatment for Chyluria via Retrograde Thoracic Duct Access

Hur, Saebeom; Gurevich, Alexey; Nadolski, Gregory J.; Itkin, Maxim

doi:10.1016/j.jvir.2021.03.410

Cited by 12 publications

(12 citation statements)

References 16 publications

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“…Nguyen et al ( 2020 ) also used interstitial lymphatic embolization and accessed the lymphatic channel by puncturing the retroperitoneal lymph node through the abdominal wall and they put a balloon catheter in the TD in order to prevent reflux of embolic agent into the TD. A recent article by Hur et al ( 2021 ) presented another approach into TD by retrograde through the left brachial vein or directly puncturing the TD followed by lymphatic embolization through a micro catheter. These treatments method for chyluria were based on disruption of the connection between renal calyces and lumbar interstitial lymphatic vessels.…”

Section: Discussionmentioning

confidence: 99%

“…As a result, not all patients respond well to these therapies (Lovrec Krstić et al 2021 ). In the literature, some new alternative treatments were applied for the management of chyluria such as interstitial lymphatic embolization through percutaneous or retrograde thoracic duct access, and interstitial lymphatic embolization with balloon plasty (Gurevich et al 2018 ; Hur et al 2021 ; Nguyen et al 2020 ). In this article, we would like to present a new interventional technique for a patient with chyluria associated with the lymphovenous junction (LVJ) obstruction.…”

Section: Introductionmentioning

confidence: 99%

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Management of chyluria using percutaneous thoracic duct stenting

Cương

Linh

et al. 2022

CVIR Endovasc

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Background Thoracic duct stenosis or obstruction is one of the causes of chyluria. Although the diagnosis of chyluria is not difficult, treatment is still challenging. Although there have been no standard guidelines for the treatment of chyluria, interventional techniques now offer minimally invasive treatment options for chyluria such as interstitial lymphatic embolization, ductoplasty with balloon, or thoracic duct stenting. Case presentation Here, we report a case of chyluria due to obstruction of the junction between the thoracic duct and subclavian vein in a 64 -year- old female patient. The patient was treated with balloon plasty for lymphovenous junction obstruction and interstitial lymphatic embolization for chyluria. However, chyluria was recurrent after 6 months so intranodal lymphangiography was performed. Anterograde thoracic duct was accessed through a transabdominal to the cisterna chyli which showed that the thoracic venous junction was re-obstruction. The patient was successfully treated by placing a uncovered drug-eluting stent with the size of 2.5 mm x 15 mm in length for resolving the thoracic occlusion. Conclusion This report demonstrates the feasibility of using thoracic duct stenting in the treatment chyluria due to lymphovenous junction obstruction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Management of chyluria using percutaneous thoracic duct stenting

Cương

Linh

et al. 2022

CVIR Endovasc

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“…[6] More recently, pre-procedural lymphangiography to identify the size and number of fistulas followed by interstitial lymphatic embolization has emerged as an effective procedure performed by interventional radiologists for patients with severely symptomatic chyluria or chyluria refractory to conservative or minimally invasive treatment. [12][13][14] More invasive surgical options include chylolymphatic disconnection with lymphovenous anastomoses or nephrectomy. [6] roughout 6 months of post-diagnosis clinical monitoring, the patient has been managed conservatively with dietary modifications.…”

Section: Discussionmentioning

confidence: 99%

Persistent chyluria following renal cryoablation: A case report

Thompson

Vogel

2022

AJIR

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Chyluria is a rare complication following renal intervention including partial nephrectomy and percutaneous ablation. To date, there are no reported cases of chyluria following renal cryoablation. An 82-year-old female patient at our institution underwent CT-guided percutaneous cryoablation for a renal cell carcinoma and presented with macroscopic fat in the urine 5 months after cryoablation. Presenting symptoms were polyuria, dysuria, and cloudy white urine. CT showed a fat-urine level in the ureter and bladder most consistent with chyluria. The patient experienced several episodes of presumptive lower urinary tract infection following diagnosis for which she was treated medically. Follow-up CT imaging 5 months post-diagnosis revealed persistent fat-fluid level in the collecting system and bladder. Operators performing renal cryoablation should be aware of the clinical and imaging manifestations of this complication.

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“…Nguyen et al [5] also used interstitial lymphatic embolization and accessed the lymphatic channel by puncturing the retroperitoneal lymph node through the abdominal wall and they put a balloon catheter in the TD in order to prevent re ux of embolic agent into the TD. A recent article by Hur et al [4] presented another approach into TD by retrograde through the left brachial vein or directly puncturing the TD followed by lymphatic embolization through a micro catheter. These treatments method for chyluria were based on disruption of the connection between renal calyces and lumbar interstitial lymphatic vessels.…”

Section: Discussionmentioning

confidence: 99%

“…As a result, not all patients respond well to these therapies [2]. In the literature, some new alternative treatments were applied for the management of chyluria such as interstitial lymphatic embolization through percutaneous or retrograde thoracic duct access, and associated with interstitial lymphatic embolization with balloon plasty [3][4][5]. However, thoracic duct stenting has not been reported in the management of chyluria up to the present.…”

Section: Introductionmentioning

confidence: 99%

Successful management of chyluria using percutaneous thoracic duct stenting

Cương

Linh

et al. 2022

Preprint

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Background Chyluria is defined as the presence of chyle in the urine that is caused by chylous reflux through the communication between the lymphatic system and the urinary tract. Thoracic duct stenosis or obstruction is one of the causes of chyluria. Although the diagnosis of chyluria is not difficult, treatment is still challenging. Although there have been no standard guidelines for the treatment of chyluria, interventional techniques now offer minimally invasive treatment options for chyluria such as interstitial lymphatic embolization, ductoplasty with balloon, or thoracic duct stenting. There are only few case reports about thoracic duct stenting in the literature. Case presentation: Here, we report a case of chyluria due to obstruction of the junction between the thoracic duct and subclavian vein in a 64 -year- old female patient. The patient was treated with balloon plasty for lymphovenous junction obstruction and interstitial lymphatic embolization for chyluria. However, chyluria was recurrent and the patient was successful treated with thoracic duct stenting. Conclusions This report demonstrates the feasibility, effective of using thoracic duct stenting in the treatment chyuria due to lymphovenous junction obstruction.

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Lymphatic Interventional Treatment for Chyluria via Retrograde Thoracic Duct Access

Cited by 12 publications

References 16 publications

Management of chyluria using percutaneous thoracic duct stenting

Management of chyluria using percutaneous thoracic duct stenting

Persistent chyluria following renal cryoablation: A case report

Successful management of chyluria using percutaneous thoracic duct stenting

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