128 - Treatment of Chylous Effusions with Thoracic Duct Embolization Using Only Liquid Embolic Agents
Wilfred Furtado, BA – Medical Student, University of Louisville; Nicholas Kemper, BS – Medical Student, University of Louisville; Rian Holayter, MD – Assistant Professor, Interventional Radiology, University of Louisville
Purpose: Chylous effusions arise from leakage intestinal lymphatic fluid from the thoracic duct into the pleural space. Causes can be traumatic, commonly from thoracic surgery, or non-traumatic, such as in the setting of malignancy. Thoracic duct embolization is a viable treatment alternative to surgery and consists of initial coil placement in the thoracic duct to provide a scaffold for glue polymerization followed by injection of a mixture of n-Butyl cyanoacrylate (n-BCA) glue and Ethiodol at the site of the leak. We present three cases of successful thoracic duct embolization using only glue.
Material and Methods: A retrospective chart review was performed of the patients that underwent glue-only thoracic duct embolization at our institution over the past year.
Results: In all three cases, the lymphatic system was visualized using bilateral inguinal lymphangiography. Once the cisterna chyli was identified, the thoracic duct was accessed by wire placement under fluoroscopy. The point of extravasation was identified for each of the patients and the glue mixture was delivered just proximal to the site. All patients demonstrated resolution of chylous effusions within days after the procedure, experienced no complications, and remained asymptomatic at the time of their most recent follow-up appointments.
Conclusions: Thoracic duct embolization is an effective method of treating chylous effusions. Although current recommendations call combined coil and glue embolization techniques, we present three cases of successful glue-only thoracic duct embolization. This technique has the additional advantages of reduced procedural cost, fluoroscopic time, and radiation exposure.