Indocyanine green-assisted chyle leak identification and ligation after left carotid-subclavian bypass: a case report

Cervical chyle leak (CL) is a rare but potentially serious complication following carotid-subclavian bypass (CSB) during cervical debranching of supraaortic vessels. We report the case of a 62-year-old male who developed a postoperative CL after staged CSB and thoracic endovascular aortic repair. Initial conservative management with dietary modification and octreotide resulted in temporary improvement; however, recurrence occurred after reintroduction of dietary fats. Surgical re-exploration with intraoperative indocyanine green (ICG) fluorescence imaging enabled precise localization and successful ligation of the leaking lymphatic vessel. Postoperative recovery was uneventful, with complete resolution of the CL. This case highlights the value of ICG-assisted imaging as a safe and effective adjunct for the diagnosis and surgical management of refractory cervical CL, particularly in patients with prosthetic vascular grafts.