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.
J Vasc Surg Venous Lymphat Disord. 2018 Nov;6(6):730-736. doi: 10.1016/j.jvsv.2018.05.023.
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.
本研究旨在确定尝试经腹胸导管置管后血管和淋巴并发症的发生率。
58 例患者行胸导管尝试置管。患者出现乳糜胸（n=40）、乳糜腹（n=9）、乳糜颈（n=8）和乳糜盆腔（n=1）。记录椎体水平和地理通道、针号、治疗用额外通道、技术成功、干预措施、即刻和迟发性并发症以及随访时间。通过影像学和电子病历在随访时对并发症和治疗效果进行评估。
在 L1（n=21）、T12（n=17）、L2（n=14）、L3（n=3）、T11（n=1）、L4（n=1）和 L5（n=1）获得了进入淋巴系统的通路。淋巴通路在椎体中心（n=28）、右侧（n=16）或左侧（n=14）获得；45 例患者使用 21 号、22 号和 25 号针，12 例患者和 1 例患者分别使用 12 号和 1 号针。15 例患者和 8 例患者分别成功进行了臂静脉和经皮锁骨下通路。52 例（89.7%）患者成功置管胸导管。41 例（70.7%）、12 例（20.7%）和 2 例（3.4%）患者进行了栓塞、断裂和支架置入；3 例（5.2%）患者在成功置管后胸导管正常。2 例（3.4%）患者出现导丝剪断的即刻并发症。对 49 例（84.5%）患者的初始随访影像学进行回顾性分析，发现以下迟发性并发症：下腔静脉和右肾静脉血栓形成和 1 例肾周淋巴积聚。
58 例尝试置管的患者中，90%的患者成功获得通路。早期和迟发性并发症发生率分别为 3.4%和 4%。胸导管置管是一种非常成功的技术，有助于治疗复杂医学患者的乳糜漏。
