Lymphatic Intervention for Chylothorax following Thoracic Aortic Surgery

Objectives: To evaluate the techniques and clinical outcomes of lymphangiogram and thoracic duct embolization (TDE) for chylothorax complicating thoracic aortic surgery. Methods: This retrospective study included nine patients (mean age = 38.9 years) who underwent interventional procedures for chylothorax following thoracic aortic surgery except valve surgery. Surgeries were aorta replacement (n = 7) with (n = 2) or without (n = 5) lung resection and vascular ring repair (n = 2). Magnetic resonance (MR) lymphangiogram was obtained in five patients. The median interval between surgery and conventional lymphangiogram was 9 days (range, 4–28 days). Clinical success of TDE was defined as lymphatic leakage resolution with chest tube removal within 2 weeks. Results: MR lymphangiogram findings in five patients were contrast leakage from the thoracic duct (n = 4) and no definite leakage (n = 1) and well-correlated with the findings of conventional lymphangiogram. Technical success of conventional lymphangiogram was 88.9% (8/9); eight showed contrast leakage, while one patient with no definite leakage on MR lymphangiogram had small inguinal lymph nodes and failed to visualize thoracic duct on conventional lymphangiogram. Technical success rates of antegrade TDE and retrograde TDE via the pleural access were 75% (6/8) and 100% (2/2), respectively. There was no difference of clinical outcome judged by tube removal day after embolization between the low (<500 mL/day) and high (>500 mL/day) output chylothorax patients. The decrease of drainage amount was statistically significant from average 710.0 to 109.7 mL/day after lymphangiogram/TDE (P < 0.05). Clinical success rate of TDE was 87.8% (7/8). Conclusion: Conventional lymphangiogram and TDE showed high technical success and encouraging clinical outcome for chylothorax complicating thoracic aortic surgery.

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Artikel online veröffentlicht:
26. April 2021