Kim Hyeongchun, Hyun Dongho, Shin Sung Wook, Jeong Guseong, Kim Jungon, Cho Jong Ho, Lee Ho Yun, Jang Yunjeong
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
J Vasc Interv Radiol. 2023 Feb;34(2):205-211. doi: 10.1016/j.jvir.2022.10.037. Epub 2022 Oct 29.
To identify key factors for successful transvenous retrograde cannulation (TVRC) of the thoracic duct.
A total of 47 consecutive patients (62.1 ± 13.2 years; 32 men) who underwent attempted TVRC between July 2016 and July 2021 were included. Reasons for interventions were chylous leakage from the chest (n = 36), abdomen (n = 6), and other sites (n = 5). Patient age, sex, access vein (femoral vs brachial), anatomic classification (presence of dominant channel vs plexiform) of the terminal thoracic duct, and engagement of a diagnostic catheter into the jugulovenous junction were included in the analyses. Anatomic details were evaluated according to catheter-based high-pressure lymphangiography and conventional intranodal lymphangiography. The Firth bias-reduced penalized-likelihood logistic regression model was used to analyze prognostic factors.
TVRC was successful in 33 of the 47 patients (70%). In univariate analysis, femoral access, diagnostic catheter engagement, and presence of dominant channel were significant positive prognostic factors (P <.05). In multivariate analysis, diagnostic catheter engagement and presence of dominant channel were significant prognostic factors (P <.05). Diagnostic catheter engagement showed the highest prognostic performance (accuracy = 0.872), followed by presence of a dominant channel. High-pressure catheter-based lymphangiographic findings showed better performance (accuracy, 0.844 vs 0.727) than intranodal lymphangiography to delineate the anatomy of the terminal thoracic duct.
A secure selection of the jugulovenous junction and the presence of a dominant channel in the terminal portion of the thoracic duct were significant prognostic factors for successful TVRC.
确定经静脉逆行插管（TVRC）成功进行胸导管插管的关键因素。
纳入2016年7月至2021年7月期间共47例连续接受TVRC尝试的患者（年龄62.1±13.2岁；男性32例）。干预原因包括胸部乳糜漏（n = 36）、腹部乳糜漏（n = 6）和其他部位乳糜漏（n = 5）。分析内容包括患者年龄、性别、入路静脉（股静脉与肱静脉）、胸导管末端的解剖分类（存在主导通道与丛状）以及诊断导管进入颈静脉交界处的情况。根据基于导管的高压淋巴管造影和传统的结内淋巴管造影评估解剖细节。采用Firth偏倚减少惩罚似然逻辑回归模型分析预后因素。
47例患者中有33例TVRC成功（70%）。单因素分析中，股静脉入路、诊断导管进入和存在主导通道是显著的阳性预后因素（P <.05）。多因素分析中，诊断导管进入和存在主导通道是显著的预后因素（P <.05）。诊断导管进入显示出最高的预后性能（准确性 = 0.872），其次是存在主导通道。基于导管的高压淋巴管造影结果在描绘胸导管末端解剖结构方面比结内淋巴管造影表现更好（准确性分别为0.844和0.727）。
安全选择颈静脉交界处以及胸导管末端存在主导通道是TVRC成功的显著预后因素。
