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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

1
Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, Ann Arbor, Mich.
2
Department of Interventional Radiology, University of California, Los Angeles, Los Angeles, Calif.
3
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: jeffreychick@gmail.com.

Abstract

OBJECTIVE:

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

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

KEYWORDS:

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

PMID:
30336901
DOI:
10.1016/j.jvsv.2018.05.023
[Indexed for MEDLINE]

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