Thoracic Duct Embolization Using Transabdominal Antegrade and Transcervical Retrograde Accesses

Area of Science:

• Interventional Radiology
• Vascular Surgery
• Gastroenterology

Background:

• Chyle leaks, often resulting from iatrogenic causes or spontaneous events, pose significant clinical challenges.
• Thoracic duct embolization (TDE) is an interventional technique used to manage chyle leaks.

Purpose of the Study:

• To evaluate the technical success and clinical outcomes of TDE.
• To compare transabdominal antegrade and transcervical retrograde access methods for TDE.

Main Methods:

• Retrospective chart review of 99 patients undergoing 113 TDE procedures over 6 years.
• Analysis of technical success rates for transabdominal antegrade and transcervical retrograde TDE.
• Assessment of overall clinical success and adverse events.

Main Results:

• Overall technical success rate for TDE was 77%.
• Transabdominal antegrade access had a 68% technical success rate; transcervical retrograde access had a 44% success rate.
• Clinical success (chyle leak resolution) was achieved in 83% of patients, with 8 SIR-classified adverse events.

Conclusions:

• Transabdominal antegrade access offers higher technical success for TDE.
• Transcervical retrograde access, though challenging, improves outcomes in cases of thoracic duct occlusion or small anatomy.
• TDE is an effective treatment for chyle leaks, with combined approaches enhancing success rates.