Thoracic Duct Venous Junction Lymphoplasty: Initial Experience and Outcomes

Tuesday, March 7, 2023

4:03 PM – 4:12 PM

Location: Phoenix Convention Center, 222C

Abstract Speaker(s)

AG

Alexey Gurevich, MD, MS

Interventional Radiology Resident
Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

Disclosure information not submitted.

Author/Co-author(s)

MA

Megan Asher, CRNP, MSN

Nurse Practitioner
Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
Gregory J. Nadolski, MD

Attending Physician
Penn Image-Guided Interventions (PIGI) Lab, Hospital of the University of Pennsylvania, Division of Interventional Radiology
Maxim Itkin, MD

Professor of Radiology
Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

Disclosure(s):

Alexey Gurevich, MD, MS: No financial relationships to disclose

Maxim Itkin, MD: 3dcirc: Ownership Interest (Ongoing); Guerbet: Consultant (Ongoing), Contracted Research (Ongoing), Speaking and Teaching (Ongoing)

Purpose:

Lymphatic system is a complex network of tissues and vessels that transport lymphatic fluid from peripheral interstitium back into the venous circulation via the thoracic duct (TD). Recent advancements in interventional lymphatic management have revolutionized the treatment of traumatic and nontraumatic lymphatic leaks, but upstream obstructions of the TD present a novel challenge. Obstruction of TD outflow increases lymphatic pressures, leading to several conditions such as lymphedema, chylous and non-chylous ascites, abdominal pain, and more. Herein we describe our early experience with Thoracic Duct Venous Junction Lymphoplasty (TDVL) for lymphatic decompression.

Materials and Methods:

Review of internal prospectively collected database was performed to identify patients who underwent TDVL between September 2020 and May 2022. Patient demographics, baseline pathological characteristics, imaging findings, procedural details, and follow-up information was collected. Procedural outcomes were stratified into complete resolution, partial resolution, temporary resolution, and failure.

Results:

Database review identified 23 patients (13M, 10F; average age of 57.3y +/- 12.5y) who underwent technically successful TDVL. All patients demonstrated signs of lymphovenous junction obstruction/stenosis on dynamic contrast-enhanced MR lymphangiography and TD lymphography. Indication for TDVL were: 11 (47.8%) ascites, bloating, and abdominal pain, 5 (21.7%) lower abdomen/extremities edema, 3 (13%) protein losing enteropathy (PLE), 2 (8.7%) neck swelling, 1 (4.3%) chest wall swelling, and 1 (4.3%) chylothorax. 6 (26.1%) patients had complete symptomatic resolution, 3 (13%) patients had partial resolution, 13 (56.5%) patients had temporary resolution of symptoms with median symptom-free duration of 14 days (ranging 5 to 180 days), and 1 (4.3%) patient had no improvement.

Conclusion:

In patients with imaging findings of lymphatic obstruction and above-mentioned clinical presentations, TDVL was effective in alleviating symptoms for 19 of 23 (82.6%) patients, proving the pathophysiological mechanism of these diseases. High symptomatic recurrence rate command further improvement of the TD venous decompression methods.