Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Interventional Radiology Treatment for Postoperative Chylothorax

  • Jun, Hoyong (Department of Radiology, Seoul National University Hospital) ;
  • Hur, Saebeom (Department of Radiology, Seoul National University Hospital)
  • Received : 2020.05.20
  • Accepted : 2020.07.01
  • Published : 2020.08.05
Download PDF
⟨ Previous Next ⟩

Abstract

Postoperative chylothorax is a rare occurrence after various thoracic surgical procedures, but it poses a substantial risk of morbidity and mortality. Thoracic duct embolization (TDE) is currently deemed the optimal treatment due to its safety and efficacy. This review offers an introduction to interventional options in this setting, detailing the steps of TDE for the edification of those engaged in postoperative care.

Keywords

References

  1. Ikomi F, Kawai Y, Ohhashi T. Recent advance in lymph dynamic analysis in lymphatics and lymph nodes. Ann Vasc Dis 2012;5:258-68. https://doi.org/10.3400/avd.ra.12.00046
  2. Hsu MC, Itkin M. Lymphatic anatomy. Tech Vasc Interv Radiol 2016;19:247-54. https://doi.org/10.1053/j.tvir.2016.10.003
  3. Dougenis D, Walker WS, Cameron EW, Walbaum PR. Management of chylothorax complicating extensive esophageal resection. Surg Gynecol Obstet 1992;174:501-6.
  4. Lai FC, Chen L, Tu YR, Lin M, Li X. Prevention of chylothorax complicating extensive esophageal resection by mass ligation of thoracic duct: a random control study. Ann Thorac Surg 2011;91:1770-4. https://doi.org/10.1016/j.athoracsur.2011.02.070
  5. Mishra PK, Saluja SS, Ramaswamy D, Bains SS, Haque PD. Thoracic duct injury following esophagectomy in carcinoma of the esophagus: ligation by the abdominal approach. World J Surg 2013;37:141-6. https://doi.org/10.1007/s00268-012-1811-x
  6. Seeliger B, Alesina PF, Walz MK. Posterior retroperitoneoscopic thoracic duct ligation: a novel surgical approach. Surg Endosc 2018;32:3732-7. https://doi.org/10.1007/s00464-018-6262-5
  7. Paul S, Altorki NK, Port JL, Stiles BM, Lee PC. Surgical management of chylothorax. Thorac Cardiovasc Surg 2009;57:226-8. https://doi.org/10.1055/s-0029-1185457
  8. Schild HH, Strassburg CP, Welz A, Kalff J. Treatment options in patients with chylothorax. Dtsch Arztebl Int 2013;110:819-26.
  9. Cerfolio RJ, Allen MS, Deschamps C, Trastek VF, Pairolero PC. Postoperative chylothorax. J Thorac Cardiovasc Surg 1996;112:1361-6. https://doi.org/10.1016/S0022-5223(96)70152-6
  10. Itkin M, Kucharczuk JC, Kwak A, Trerotola SO, Kaiser LR. Nonoperative thoracic duct embolization for traumatic thoracic duct leak: experience in 109 patients. J Thorac Cardiovasc Surg 2010;139:584-90. https://doi.org/10.1016/j.jtcvs.2009.11.025
  11. Laslett D, Trerotola SO, Itkin M. Delayed complications following technically successful thoracic duct embolization. J Vasc Interv Radiol 2012;23:76-9. https://doi.org/10.1016/j.jvir.2011.10.008
  12. Pamarthi V, Stecker MS, Schenker MP, et al. Thoracic duct embolization and disruption for treatment of chylous effusions: experience with 105 patients. J Vasc Interv Radiol 2014;25:1398-404. https://doi.org/10.1016/j.jvir.2014.03.027
  13. Yannes M, Shin D, McCluskey K, Varma R, Santos E. Comparative analysis of intranodal lymphangiography with percutaneous intervention for postsurgical chylous effusions. J Vasc Interv Radiol 2017;28:704-11. https://doi.org/10.1016/j.jvir.2016.12.1209
  14. Cope C, Kaiser LR. Management of unremitting chylothorax by percutaneous embolization and blockage of retroperitoneal lymphatic vessels in 42 patients. J Vasc Interv Radiol 2002;13:1139-48. https://doi.org/10.1016/S1051-0443(07)61956-3
  15. Rajebi MR, Chaudry G, Padua HM, et al. Intranodal lymphangiography: feasibility and preliminary experience in children. J Vasc Interv Radiol 2011;22:1300-5. https://doi.org/10.1016/j.jvir.2011.05.003
  16. Kim SW, Hur S, Kim SY, et al. The efficacy of lymph node embolization using N-butyl cyanoacrylate compared to ethanol sclerotherapy in the management of symptomatic lymphorrhea after pelvic surgery. J Vasc Interv Radiol 2019;30:195-202. https://doi.org/10.1016/j.jvir.2018.09.038
  17. Bielsa S, Pardina M. Refractory chylothorax: where do we go now? Curr Pulmonol Rep 2019;8:60-7. https://doi.org/10.1007/s13665-019-0226-7
  18. Kim PH, Tsauo J, Shin JH. Lymphatic interventions for chylothorax: a systematic review and meta-analysis. J Vasc Interv Radiol 2018;29:194-202. https://doi.org/10.1016/j.jvir.2017.10.006
  19. Kuetting D, Schild HH, Pieper CC. In vitro evaluation of the polymerization properties of N-butyl cyanoacrylate/iodized oil mixtures for lymphatic interventions. J Vasc Interv Radiol 2019;30:110-7. https://doi.org/10.1016/j.jvir.2018.07.028
  20. Schild HH, Pieper CC. Where have all the punctures gone?: an analysis of thoracic duct embolizations. J Vasc Interv Radiol 2020;31:74-9. https://doi.org/10.1016/j.jvir.2019.09.012
  21. Kortes N, Radeleff B, Sommer CM, et al. Therapeutic lymphangiography and CT-guided sclerotherapy for the treatment of refractory lymphatic leakage. J Vasc Interv Radiol 2014;25:127-32. https://doi.org/10.1016/j.jvir.2013.10.011
  22. Matsumoto T, Yamagami T, Kato T, et al. The effectiveness of lymphangiography as a treatment method for various chyle leakages. Br J Radiol 2009;82:286-90. https://doi.org/10.1259/bjr/64849421
  23. Kos S, Haueisen H, Lachmund U, Roeren T. Lymphangiography: forgotten tool or rising star in the diagnosis and therapy of postoperative lymphatic vessel leakage. Cardiovasc Intervent Radiol 2007;30:968-73. https://doi.org/10.1007/s00270-007-9026-5
  24. Gruber-Rouh T, Naguib NNN, Lehnert T, et al. Direct lymphangiography as treatment option of lymphatic leakage: indications, outcomes and role in patient's management. Eur J Radiol 2014;83:2167-71. https://doi.org/10.1016/j.ejrad.2014.09.013
  25. Alejandre-Lafont E, Krompiec C, Rau WS, Krombach GA. Effectiveness of therapeutic lymphography on lymphatic leakage. Acta Radiol 2011;52:305-11. https://doi.org/10.1258/ar.2010.090356
  26. Kawasaki R, Sugimoto K, Fujii M, et al. Therapeutic effectiveness of diagnostic lymphangiography for refractory postoperative chylothorax and chylous ascites: correlation with radiologic findings and preceding medical treatment. AJR Am J Roentgenol 2013;201:659-66. https://doi.org/10.2214/AJR.12.10008
  27. Pieper CC, Hur S, Sommer CM, et al. Back to the future: lipiodol in lymphography: from diagnostics to theranostics. Invest Radiol 2019;54:600-15. https://doi.org/10.1097/rli.0000000000000578
  28. Binkert CA, Yucel EK, Davison BD, Sugarbaker DJ, Baum RA. Percutaneous treatment of high-output chylothorax with embolization or needle disruption technique. J Vasc Interv Radiol 2005;16:1257-62. https://doi.org/10.1097/01.RVI.0000167869.36093.43

Cited by

  1. Non-conservative Management of Chylothorax vol.54, pp.4, 2021, https://doi.org/10.5090/jcs.21.056