Treatment of Postsurgical Chylothorax

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Presentation transcript:

Treatment of Postsurgical Chylothorax Janani S. Reisenauer, MD, Carlos A. Puig, MD, Chris J. Reisenauer, MD, Mark S. Allen, MD, Emily Bendel, MD, Stephen D. Cassivi, MD, Francis C. Nichols, MD, Rob K. Shen, MD, Dennis A. Wigle, MD, Shanda H. Blackmon, MD The Annals of Thoracic Surgery Volume 105, Issue 1, Pages 254-262 (January 2018) DOI: 10.1016/j.athoracsur.2017.07.021 Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Thoracic duct anatomy. (B) Chylothorax secondary to thoracic duct leak after thoracic operation. (Published with permission of Mayo Foundation for Medical Education and Research.) The Annals of Thoracic Surgery 2018 105, 254-262DOI: (10.1016/j.athoracsur.2017.07.021) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Thoracic duct embolization technique. (Left) A needle is inserted directly into the subdiaphragmatic thoracic duct to access the thoracic duct. (Right) Embolization is performed with microcoils and liquid embolic agent across the chyle leak. The Annals of Thoracic Surgery 2018 105, 254-262DOI: (10.1016/j.athoracsur.2017.07.021) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Thoracic duct ligation/SDL technique. (Left) At T8, the typical area of SDL, the duct can be visualized from the right hemithorax. (Right) Thoracic duct is typically ligated low in the chest. (SDL = surgical duct ligation.) (Published with permission of Mayo Foundation for Medical Education and Research.) The Annals of Thoracic Surgery 2018 105, 254-262DOI: (10.1016/j.athoracsur.2017.07.021) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Initial and subsequent treatment modalities of the cohort. (NPO = nil per os; SDL = surgical duct ligation; TDE = thoracic duct embolization; TPN = total parenteral nutrition.) The Annals of Thoracic Surgery 2018 105, 254-262DOI: (10.1016/j.athoracsur.2017.07.021) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Second embolization procedure after the first embolization failed to demonstrate the second portal of leakage. The Annals of Thoracic Surgery 2018 105, 254-262DOI: (10.1016/j.athoracsur.2017.07.021) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Algorithm for management of postoperative chylothorax. (CT = chest tube; NPO = nil per os; TDE = thoracic duct embolization; TPN = total parenteral nutrition.) The Annals of Thoracic Surgery 2018 105, 254-262DOI: (10.1016/j.athoracsur.2017.07.021) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions