Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University St. Louis School of Medicine, St. Louis, Missouri.
Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University St. Louis School of Medicine, St. Louis, Missouri.
J Vasc Interv Radiol. 2022 Dec;33(12):1536-1541. doi: 10.1016/j.jvir.2022.08.022. Epub 2022 Aug 24.
To evaluate the technical success and clinical outcomes of thoracic duct embolization (TDE) using transabdominal antegrade and transcervical retrograde accesses to treat patients with chyle leak.
This study was a retrospective, nonblinded, single-institution chart review of all patients aged 18 years or older over a 6-year time frame who underwent lymphangiography with attempted TDE for iatrogenic or spontaneous chyle leaks using transabdominal antegrade and/or transcervical retrograde accesses.
Ninety-nine patients underwent 113 procedures. Eighty-five patients underwent 1 procedure, and 14 patients required 2 procedures. The technical success rate of TDE was 68% (72/106) with transabdominal antegrade access and 44% (15/34) with transcervical retrograde access. The overall technical success rate of TDE, including both the access methods, was 77% (87/113). The most common reasons for transabdominal access failure were small caliber of the cisterna chyli and thoracic duct (TD) occlusion. Five patients were lost to follow-up. Overall clinical success, defined as resolution of the chyle leak, was achieved in 83% (78/94) of the patients. There were 6 Society of Interventional Radiology (SIR) level 1 adverse events (AEs), 5 SIR level 2 AEs, and 2 SIR level 3 AEs. Nontarget embolization occurred in 2 patients.
Although transcervical retrograde TDE is a challenging procedure, with a lower technical success rate than transabdominal antegrade access, retrograde access improved the technical and clinical success rates of the treatment of chyle leaks in cases of thoracic duct occlusion, small cisterna chyli, and leaks located in the abdomen.
评估经腹腔前路和经颈后路逆行入路行胸导管栓塞术（TDE）治疗乳糜漏患者的技术成功率和临床疗效。
本研究为回顾性、非盲、单中心研究，对 6 年内所有年龄在 18 岁及以上、行淋巴管造影并尝试经腹腔前路和/或经颈后路逆行入路行 TDE 治疗医源性或自发性乳糜漏的患者进行了图表回顾。
99 例患者共行 113 次手术。85 例患者行 1 次手术，14 例患者行 2 次手术。经腹腔前路入路 TDE 的技术成功率为 68%（72/106），经颈后路入路为 44%（15/34）。两种入路方法的 TDE 总技术成功率为 77%（87/113）。经腹腔前路入路失败的主要原因是胸导管（TD）和乳糜池口径小和闭塞。5 例患者失访。定义为乳糜漏解决的总体临床成功率为 83%（78/94）。有 6 例发生了 SIR 1 级不良事件（AE），5 例发生了 SIR 2 级 AE，2 例发生了 SIR 3 级 AE。有 2 例发生了非靶向栓塞。
尽管经颈后路 TDE 是一项具有挑战性的操作，其技术成功率低于经腹腔前路入路，但在胸导管闭塞、乳糜池较小和腹部漏的情况下，逆行入路提高了 TDE 治疗乳糜漏的技术和临床成功率。
