Selective Retrograde Thoracic Duct Embolization

2018 ◽  
Author(s):  
Abdulrahman Masrani ◽  
Bulent Arslan
Keyword(s):  
Interventional Radiology ◽  
Neck Dissection ◽  
Thoracic Duct ◽  
Lymphatic Drainage ◽  
Main Duct ◽  
Potential Complication ◽  
Wound Site ◽  
Dietary Changes ◽  
Secondary Lymphedema ◽  
Chylous Fistula

Thoracic duct injury is potential complication of neck surgeries, especially surgeries that include neck dissection. It can present as a lymphatic drainage at the wound site, chylous fistula, chylothorax, chylomediastinum, chylopericardium, lymphocele, persistent lymphorrhea, or secondary lymphedema. This complication is managed with intraoperative repair of the injury if recognized, conservative measures of dietary changes and octeriotide, thoracic duct embolization by interventional radiology, or surgical re-exploration of the wound with repair of the injury. This chapter describes a technique to selectively embolize the injured lymphatic branch of the thoracic duct utilizing coils and Onyx instead of embolizing the main duct. This technique eliminates the need for nodal or pedal lymphogram and thus saves time, effort, and reduces expense.

Usefulness of thoracic duct clipping in thoracoscopic surgery for chylous fistula occurring after neck dissection

2013 ◽  
Vol 3 (3) ◽  
pp. 158-160 ◽  
Author(s):  
Soichiro Takase ◽  
Kiyoaki Tsukahara ◽  
Yoshiaki Osaka ◽  
Kazuhiro Nakamura ◽  
Ray Motohashi ◽  
...  
Keyword(s):  
Neck Dissection ◽  
Thoracic Duct ◽  
Thoracoscopic Surgery ◽  
Chylous Fistula

Lymphatic Drainage System after Left Radical Neck Dissection

1994 ◽  
Vol 103 (1) ◽  
pp. 46-48 ◽  
Author(s):  
Gady Har-El ◽  
Frank E. Lucente
Keyword(s):  
Pleural Effusion ◽  
Neck Dissection ◽  
Thoracic Duct ◽  
Lymphatic Vessel ◽  
Lymphatic System ◽  
Radical Neck Dissection ◽  
Drainage System ◽  
Lymphatic Drainage ◽  
Venous System ◽  
Collateral System

The thoracic duct is the main lymphatic vessel that drains most of the body's lymph and all of the intestinal chyle into the venous system. The thoracic duct may be ligated during left radical neck dissection (RND) without any significant sequelae. The lymphatic system must, therefore, have collateral channels. The present study shows an increased incidence of pleural effusion after left RND when compared to right RND. We suggest that this represents the inability of the collateral system to immediately accommodate the increased volume of chyle.

scholarly journals Lymphangiography and focal pleurodesis treatment of chylothorax with an aberrant thoracic duct following oesophagectomy: a case report

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Tomoyuki Ishida ◽  
Jun Kanamori ◽  
Hiroyuki Daiko
Keyword(s):  
Magnetic Resonance Imaging ◽  
Interventional Radiology ◽  
Case Report ◽  
Magnetic Resonance ◽  
Thoracic Duct ◽  
Rare Case ◽  
Resonance Imaging ◽  
Case Presentation ◽  
Thoracostomy Tube ◽  
Magnetic Resonance Imaging Mri

Abstract Background Management of postoperative chylothorax usually consists of nutritional regimens, pharmacological therapies such as octreotide, and surgical therapies such as ligation of thoracic duct, but a clear consensus is yet to be reached. Further, the variation of the thoracic duct makes chylothorax difficult to treat. This report describes a rare case of chylothorax with an aberrant thoracic duct that was successfully treated using focal pleurodesis through interventional radiology (IVR). Case presentation The patient was a 52-year-old man with chylothorax after a thoracoscopic oesophagectomy for oesophageal cancer. With conventional therapy, such as thoracostomy tube, octreotide or fibrogammin, a decrease in the amount of chyle was not achieved. Therefore, we performed lymphangiography and pleurodesis through IVR. The patient appeared to have an aberrant thoracic duct, as revealed by magnetic resonance imaging (MRI); however, after focal pleurodesis, the leak of chyle was diminished, and the patient was discharged 66 days after admission. Conclusions Chylothorax remains a difficult complication. Focal pleurodesis through IVR can be one of the options to treat chylothorax.

Thoracic Duct Embolization: A New Treatment for Massive Leak After Neck Dissection

2008 ◽  
Vol 118 (4) ◽  
pp. 680-683 ◽  
Author(s):  
Neel Patel ◽  
Robert J. Lewandowski ◽  
Michiel Bove ◽  
Albert A. Nemcek ◽  
Riad Salem
Keyword(s):  
Neck Dissection ◽  
Thoracic Duct ◽  
New Treatment

Lympedema Therapies

2021 ◽  
Author(s):  
Shailesh Agarwal ◽  
Catherine Wu
Keyword(s):  
Lymph Node ◽  
Drainage Basin ◽  
Parasitic Infection ◽  
Surgical Techniques ◽  
Lymphatic Drainage ◽  
The United States ◽  
Secondary Lymphedema ◽  
Complete Decongestive Therapy ◽  
Infection Treatment ◽  
Lymph Node Transfer

Secondary lymphedema refers to a condition in which the affected extremity develops progressive hypertrophy due to lymphatic fluid retention. Worldwide, secondary lymphedema is most often associated with parasitic infection; within the United States, secondary lymphedema is most often caused by surgical disruption of the lymphatic drainage basins due to cancer surgery and/or radiation. For patients with lymphedema secondary to parasitic infection, treatment of the offending infectious organism (Wuchereria bancroftii) is critical. For patients with surgical disruption of the lymphatic drainage basin(s), patients are first managed non-operatively with compression and manual lymphatic drainage massage. Over the past decade, surgical techniques have been developed and implemented to improve lymphatic drainage for patients with post-surgical secondary lymphedema. These procedures, including lymphovenous bypass or vascularized lymph node transfer, are aimed at reconstituting lymphatic drainage and reducing lymphatic retention to alleviate early lymphedema. An appreciation of the underlying physiology responsible for secondary lymphedema, and diagnosis and management is required to provide timely and appropriate care for these patients. This review contains 2 tables, 4 figures, and 32 references Keywords: lymphedema, lymphedema treatment, secondary lymphedema, complete decongestive therapy, lymphovenous bypass, vascularized lymph node transplantation, debulking surgery, ICG lymphangiography, lymphedema staging

Bioimpedance spectroscopy and volumetry in the immediate/short-term monitoring of intensive complex decongestive treatment of lymphedema

2020 ◽  
Vol 35 (9) ◽  
pp. 715-723 ◽  
Author(s):  
Attilio Cavezzi ◽  
Simone U Urso ◽  
Stefania Paccasassi ◽  
Giovanni Mosti ◽  
Fausto Campana ◽  
...  
Keyword(s):  
Lower Limb ◽  
Lymphatic Drainage ◽  
Lower Leg ◽  
Mean Value ◽  
Treatment Manual ◽  
Spectroscopy Data ◽  
Bioimpedance Spectroscopy ◽  
Short Term ◽  
Secondary Lymphedema ◽  
Term Monitoring

Aims To assess (a) immediate/short-term outcomes of intensive complex decongestive treatment of lower limb lymphedema, by means of bioimpedance spectroscopy and tape measurement-based volumetry, and (b) correlation between these two methods. Patients and methods Cohort study on patients affected by unilateral primary or secondary lymphedema, stage II or III. Patients underwent complex decongestive treatment (manual and electro-sound lymphatic drainage, compression bandage, exercises, low-carb nutrition, and dietary supplements) for six days. Before (D0), three and six days after complex decongestive treatment (D3 and D6), volumetry and bioimpedance spectroscopy data of the total limb and lower leg were collected. Statistical analysis was applied to pre–post treatment outcomes and to the volumetry/bioimpedance spectroscopy correlation. Results Forty-one patients (15 males and 26 females, mean age: 50.7 years) were included. A progressive improvement of volumetry and bioimpedance spectroscopy figures was recorded. Total limb and leg volumetry (mean value in cc) was, respectively, 11,072.9 and 3150.8 at D0, 10,493 (−5.2%, p = 0.001) and 2980.2 (−5.4%, p < 0.001) at D6. Total limb lymphatic index at D0 and D6 was 18.9 and 14.8 (−21.5%, p < 0.001). Total limb resistance at D0, D3, and D6 was 200.4, 225.7, and 237.5 (+18.5%, p < 0.001), respectively; leg resistance at D0 and D6 was 117.5 and 150 (+27.7%, p < 0.001), respectively. Total limb reactance at D0, D3, and D6 was 12.2, 15, and 16.6 (+35.5%, p < 0.001), respectively. Leg reactance at D0 and D6 was 7.7 and 11.5 (+ 49.6%, p < 0001), respectively. Correlation volumetry/bioimpedance spectroscopy data were (a) total limb volumetry/resistance rho = −0.449, p < 0.01; volumetry/reactance rho=−0.466, p < 0.01; volumetry/lymphatic index rho = 0.581, p < 0.01; (b) leg volumetry/resistance rho=−0.579, p < 0.01; volumetry/reactance rho=−0.469, p < 0.01; volumetry/lymphatic index rho = 0.466, p < 0.05. Conclusions Complex decongestive treatment on lymphedematous limbs was effective at short term; both volumetry and bioimpedance spectroscopy showed a statistically significant improvement. Resistance and reactance increase, with lymphatic index decrease, correlated with volumetry decrease. Bioimpedance spectroscopy proved to help to assess fluid decrease and the tissue-related parameters variations.

scholarly journals Conservative Management of Postoperative Chylous Fistula with Octreotide and Peripheral Total Parenteral Nutrition

2017 ◽  
Vol 96 (7) ◽  
pp. 264-267 ◽  
Author(s):  
Jason Y.K. Chan ◽  
Eddy W.Y. Wong ◽  
S.K. Ng ◽  
C. Andrew van Hasselt ◽  
Alexander C. Vlantis
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Neck Dissection ◽  
Conservative Management ◽  
Surgical Intervention ◽  
Case Series ◽  
Somatostatin Analogue ◽  
Left Neck ◽  
Neck Irradiation ◽  
Chylous Fistula

Postoperative chylous fistula after neck dissection is an uncommon complication associated with significant patient morbidity. Octreotide acetate is a somatostatin analogue established in the treatment of chylothorax; however, its utility in the management of cervical chylous fistulae has not been fully evaluated. The investigators hypothesized that chylous fistula can be managed by a combination of octreotide and peripheral total parenteral nutrition (TPN). A retrospective review of cases compiled at our institution from 2009 to 2015 was conducted. Ten patients, all men, were identified as having a postoperative chylous fistula after a neck dissection. All patients were treated with peripheral TPN. and intravenous octreotide. Mean age of the patients was 63.0 years (range 49 to 82). Five (50.0%) had a neck dissection for the management of metastatic nasopharyngeal carcinoma and had previous neck irradiation. In 8 (80%) patients, chylous fistula occurred in the left neck. Seven (70.0%) of the leaks occurred within the first 2 postoperative days. Eight (80%) leaks were controlled using TPN and octreotide, with 2 (20%) patients requiring surgical intervention. No factors were significant in the successful conservative management of chylous fistulae. One patient with a chylous fistula of 1,800 ml/day was managed successfully without surgical intervention. The results of this case series suggest that chylous fistulae may be managed conservatively with octreotide and TPN. However, long-term evaluation is needed to define if and when surgical intervention is required for control.

scholarly journals Conservative Management of Postoperative Chylous Fistula with Octreotide and Peripheral Total Parenteral Nutrition

2017 ◽  
Vol 96 (7) ◽  
pp. 264-267 ◽  
Author(s):  
Jason Y.K. Chan ◽  
Eddy W.Y. Wong ◽  
S.K. Ng ◽  
C. Andrew van Hasselt ◽  
Alexander C. Vlantis
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Neck Dissection ◽  
Conservative Management ◽  
Surgical Intervention ◽  
Case Series ◽  
Somatostatin Analogue ◽  
Left Neck ◽  
Neck Irradiation ◽  
Chylous Fistula

Postoperative chylous fistula after neck dissection is an uncommon complication associated with significant patient morbidity. Octreotide acetate is a somatostatin analogue established in the treatment of chylothorax; however, its utility in the management of cervical chylous fistulae has not been fully evaluated. The investigators hypothesized that chylous fistula can be managed by a combination of octreotide and peripheral total parenteral nutrition (TPN). A retrospective review of cases compiled at our institution from 2009 to 2015 was conducted. Ten patients, all men, were identified as having a postoperative chylous fistula after a neck dissection. All patients were treated with peripheral TPN and intravenous octreotide. Mean age of the patients was 63.0 years (range 49 to 82). Five (50.0%) had a neck dissection for the management of metastatic nasopharyngeal carcinoma and had previous neck irradiation. In 8 (80%) patients, chylous fistula occurred in the left neck. Seven (70.0%) of the leaks occurred within the first 2 postoperative days. Eight (80%) leaks were controlled using TPN and octreotide, with 2 (20%) patients requiring surgical intervention. No factors were significant in the successful conservative management of chylous fistulae. One patient with a chylous fistula of 1,800 ml/day was managed successfully without surgical intervention. The results of this case series suggest that chylous fistulae may be managed conservatively with octreotide and TPN. However, long-term evaluation is needed to define if and when surgical intervention is required for control.

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