PMID- 36028207
OWN - NLM
STAT- MEDLINE
DCOM- 20221222
LR  - 20230308
IS  - 1535-7732 (Electronic)
IS  - 1051-0443 (Linking)
VI  - 33
IP  - 12
DP  - 2022 Dec
TI  - Thoracic Duct Embolization Using Transabdominal Antegrade and Transcervical 
      Retrograde Accesses.
PG  - 1536-1541
LID - S1051-0443(22)01157-5 [pii]
LID - 10.1016/j.jvir.2022.08.022 [doi]
AB  - PURPOSE: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
CI  - Copyright (c) 2022 SIR. Published by Elsevier Inc. All rights reserved.
FAU - Crawford, Daniel
AU  - Crawford D
AD  - Division of Interventional Radiology, Mallinckrodt Institute of Radiology, 
      Washington University St. Louis School of Medicine, St. Louis, Missouri.
FAU - Guevara, Carlos J
AU  - Guevara CJ
AD  - Division of Interventional Radiology, Mallinckrodt Institute of Radiology, 
      Washington University St. Louis School of Medicine, St. Louis, Missouri.
FAU - Kim, Seung Kwon
AU  - Kim SK
AD  - Division of Interventional Radiology, Mallinckrodt Institute of Radiology, 
      Washington University St. Louis School of Medicine, St. Louis, Missouri. 
      Electronic address: skim35@wustl.edu.
LA  - eng
PT  - Journal Article
DEP - 20220824
PL  - United States
TA  - J Vasc Interv Radiol
JT  - Journal of vascular and interventional radiology : JVIR
JID - 9203369
SB  - IM
MH  - Humans
MH  - *Chylothorax/diagnostic imaging/etiology/therapy
MH  - *Embolization, Therapeutic/adverse effects/methods
MH  - Lymphography/methods
MH  - Retrospective Studies
MH  - Thoracic Duct/diagnostic imaging
MH  - Treatment Outcome
EDAT- 2022/08/27 06:00
MHDA- 2022/12/06 06:00
CRDT- 2022/08/26 19:28
PHST- 2022/04/26 00:00 [received]
PHST- 2022/07/25 00:00 [revised]
PHST- 2022/08/17 00:00 [accepted]
PHST- 2022/08/27 06:00 [pubmed]
PHST- 2022/12/06 06:00 [medline]
PHST- 2022/08/26 19:28 [entrez]
AID - S1051-0443(22)01157-5 [pii]
AID - 10.1016/j.jvir.2022.08.022 [doi]
PST - ppublish
SO  - J Vasc Interv Radiol. 2022 Dec;33(12):1536-1541. doi: 10.1016/j.jvir.2022.08.022. 
      Epub 2022 Aug 24.