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J Vasc Surg Venous Lymphat Disord. 2018 Nov;6(6):730-736. doi: 10.1016/j.jvsv.2018.05.023.

Vascular and lymphatic complications after thoracic duct cannulation.

Author information

Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, Ann Arbor, Mich.
Department of Interventional Radiology, University of California, Los Angeles, Los Angeles, Calif.
Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, Ann Arbor, Mich; Cardiovascular and Interventional Radiology, Inova Alexandria Hospital, Alexandria, Va. Electronic address:



The objective of this study was to determine the incidence of vascular and lymphatic complications after attempted transabdominal thoracic duct cannulation.


There were 58 patients who underwent attempted thoracic duct cannulation. Patients presented with chyle leak in the chest (n = 40), abdomen (n = 9), neck (n = 8), and pelvis (n = 1). Vertebral body level and geographic access, needle gauge, additional access for treatment, technical success, intervention performed, immediate and delayed complications, and follow-up duration were recorded. Imaging and electronic medical records were reviewed at follow-up for complications and treatment success.


Access into the lymphatic system was obtained at L1 (n = 21), T12 (n = 17), L2 (n = 14), L3 (n = 3), T11 (n = 1), L4 (n = 1), and L5 (n = 1). Lymphatic access was achieved in the center (n = 28), on the right (n = 16), or on the left (n = 14) of the vertebral body; 21-, 22-, and 25-gauge needles were used in 45 patients, 12 patients, and 1 patient, respectively. Arm venous and percutaneous supraclavicular access was successful in 15 patients and eight patients, respectively. Cannulation of the thoracic duct was achieved in 52 (89.7%) patients. Embolization, disruption, and stenting were performed in 41 (70.7%), 12 (20.7%), and 2 (3.4%) patients; 3 (5.2%) patients had normal thoracic ducts after successful cannulation. Immediate complications consisted of shearing of the access wire in two (3.4%) patients. Retrospective analysis of initial follow-up imaging in 49 (84.5%) patients revealed the following late complications: inferior vena cava and right renal vein thrombosis and one perinephric lymphatic collection.


Of 58 patients who had attempted thoracic duct cannulation, successful access was achieved in 90% of patients. Early and delayed complications occurred in 3.4% and 4% of patients, respectively. Thoracic duct cannulation represents a highly successful technique that aids in the treatment of chyle leaks in medically complex patients.


Arterial; Lymphatic complications; Lymphatics; Thoracic duct cannulation; Thoracic duct embolization; Vascular complications; Venous

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