Percutaneous treatment of thoracic duct injuries

Abstract

The percutaneous management of chyle leak is feasible, with low morbidity and mortality rates and a high rate of effectiveness. This approach should be considered before more invasive procedures.

The Role for Tunneled Indwelling Pleural Catheters in Patients With Persistent Benign Chylothorax

“…[7][8][9][10] Surgical and percutaneous radiological interventions (eg, thoracic duct ligation/embolization, pleuroperitoneal shunting, chemical pleurodesis) may be effective but can be associated with morbidity and mortality. [11][12][13][14][15][16] Octreotide therapy has been used with variable efficacy in a predominantly pediatric population. [17][18][19] Concerns regarding serial thoracenteses leading to significant volume and protein loss resulting in nutritional, immunologic and hemodynamic complications have led to the commonly held assertion that TIPCs should not be used to manage persistent benign chylous pleural effusions.…”

Thoracic duct embolization for the management of chylothoraces

“…Although these results are promising, the operative risk, morbidity, and poorer outcomes of surgical ligation compared with TDE make TDE the preferred alternative to surgical ligation to treat chylothoraces [4,5,8 && ,9,19]. The growing experience with TDE supports its use as the first-line treatment for traumatic chylothorax [20].…”

“…A recent case report described an incident of chylous ascites occurring in a patient with a chylothorax who had a failed attempt at cannulating the thoracic duct [26]. This complication had not been observed in prior studies of TDE, which included cases of failed thoracic duct cannulation [5,20,23 && ]. In a long-term follow-up of 106 patients who underwent TDE, four patients developed chronic leg swelling and four patients were noted to have developed chronic diarrhea that was thought to be 'probably related' to the procedure.…”

Evaluatıon of Chylothorax: Etiology, Clınıcal Symptoms, Diagnosıs and Treatment Methods

“…Konservatif ve cerrahi yaklaşımlar dışında şilotoraksın tedavisinde alternatif yöntemleri de gözden geçirmek gerekir. Talk veya povidoneiodine yada son yıllarda popüler olan OK-432 (pikibasil) ile plörodezis uygulanması, tetrasiklin ile dilate lenfatiklere sikleroterapi tatbiki, platinyum koillerle duktus torasikus'a floroskopik embolizasyon ve plöroperitoneal şant ve plörektomi bu alternatif tedaviler arasındadır (18,23). Sonuç olarak; şilotoraks gecikmiş tedavi sonucu morbidite ve mortalite riski yüksek bir patoloji olup, tanı biyokimyasal yöntemlerle kesinleştikten sonra tedaviye hemen başlanmalıdır.…”