Thoracic Duct Embolization and Disruption for Treatment of Chylous Effusions: Experience with 105 Patients

Review article: the diagnostic approach and current management of chylous ascites

“…A number of additional therapeutic strategies have been trialed for refractory chylous ascites including glue embolization, spleno‐renal shunt, surgical ligation and embolization of disrupted lymphatic channels, but the data is preliminary . Peritoneovenous shunting was used in the past, however, it is rarely performed nowadays due to its high morbidity from sepsis, electrolyte imbalance, disseminated intravascular coagulopathy, small bowel obstruction and air embolism .…”

Therapeutic role of ultrasound-guided intranodal lymphangiography in refractory cervical chylous leakage after neck dissection: Report of a case and review of the literature

“…However, the procedure is technically challenging and the catheterization success rate is only about 67%. In another series of 105 patients in which a total of 120 procedures were done, technical success was reported as 79% . The ability to catheterize the thoracic duct is strongly correlated with operator experience and is dependent on the availability of suitably sized cisterna chyli or retroperitoneal lymphatic trunks .…”

“…When catheterization is not possible, it is advocated to perform thoracic duct disruption via needle laceration of lymphatic vessels by repeated probing, twisting, or to‐and‐fro “twiddling” motions. The success rate with thoracic duct disruption ranged from 43% to 72% in different series . It is hypothesized that needle disruption decreases chylous leakage by slowing down the lymphatic flow, which in turn allows the body to seal the leak.…”

Overview of treatment related complications in malignant pleural mesothelioma

“…Diagnosis can be confirmed by checking the fluid triglyceride level, which is usually elevated (53). Interventional radiology guided thoracic duct embolization is often the initial treatment of choice; this involves catheterization of the cisterna chyli, performing a lymphangiogram to identify the source of leak and embolization of the thoracic duct proximal to the site of leak (Figure 9) (54). Non-contract MRI is useful prior to this procedure, helps in localization of the cisterna chyli and thoracic duct, facilitating percutaneous access (54).…”