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Selective Lymphatic Duct Embolization for Treatment of Thoracic Lymphatic Flow Disorders in Children: Technical
Abhay Srinivasan1, Christopher L Smith2, Ganesh Krishnamurthy1
1Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Purpose:
To assess effectiveness of selective lymphatic duct embolization (SLDE) for treatment of thoracic lymphatic flow disorders, performed to maintain patency of the thoracic duct (TD), compared with that of TD embolization (TDE).
Materials And Methods:
Records of 39 patients (mean age, 7.6 years [SD ± 7.1]) with thoracic lymphatic flow disorders who underwent 43 SLDE procedures were analyzed and compared with a cohort of 104 patients (mean age, 7.8 years [SD ± 7.6]) who underwent TDE. Relevant clinical and imaging data were collated. All patients presented with chylous effusion and/or plastic bronchitis. For the SLDE cohort, etiology of disorders included single-ventricle heart disease palliation in 28 patients (72%) and vascular malformation/aneuploidy in 8 patients (21%). For the TDE cohort, 92 of 104 (88%) had single-ventricle heart disease palliation.
Results:
SLDE was performed using n-butyl cyanoacrylate glue via microcatheter in 35 procedures, and dextrose flood technique was used in 26. SLDE via direct needle access was performed in 11. After SLDE, presenting symptoms resolved in 33 of 39 patients (85%), improved in 5 (13%), and were unchanged in 1 (3%; mean follow-up, 693 days [SD ± 523]). The TD remained patent in all cases. There was a significant difference in outcomes (P = .001) with the TDE cohort-symptoms resolved or improved in 75 of 104 patients (72%) and were unchanged in 15 (14%), and new leak (eg, ascites and protein-losing enteropathy) developed in 14 patients who underwent TDE (13%; follow-up, 1,041 days [SD ± 879]).
Conclusions:
SLDE was effective for treatment of thoracic lymphatic flow disorders, and outcomes were comparable with those of TDE. Selective techniques preserve the patency of the TD and may have potential benefits that warrant further study.
