Thoracic duct stent-graft decompression with 3-month patency: Revisiting a historical treatment option for portal hypertension

Area of Science:

• Interventional Radiology
• Hepatology
• Vascular Surgery

Background:

• Portal hypertension in cirrhosis leads to elevated thoracic duct flow and pressure.
• Traditional treatments for portal hypertension complications include thoracic duct drainage and lymphovenous bypass.
• Minimally invasive techniques are sought for managing complex cirrhotic complications.

Observation:

• A patient with cirrhosis, portal hypertension, and variceal hemorrhage underwent thoracic duct stent-graft placement.
• The procedure aimed to decompress the thoracic duct across the lymphovenous junction.
• Initial venography showed partial stent-graft patency with fibrin sheath formation.

Findings:

• Percutaneous thoracic duct stent-graft placement successfully resolved acute variceal hemorrhage.
• Endoscopy confirmed decompression of bleeding varices post-procedure.
• Stent-graft revision achieved full patency at 3-month follow-up, preventing recurrent hemorrhage.

Implications:

• Thoracic duct stent-graft decompression offers a potential minimally invasive treatment for cirrhotic portal hypertension.
• This technique may provide an alternative to traditional surgical interventions for variceal bleeding.
• Further research is warranted to establish the long-term efficacy and safety of this approach.