Boston - American Association for Thoracic Surgery

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89 TH ANNUAL MEETING MAY 9–MAY 13, 2009BOSTON, MASSACHUSETTSTUESDAY MORNINGMAY 12, 20098:45 a.m. PLENARY SCIENTIFIC SESSIONBallroom A–C, Hynes Convention Center(8 minutes presentation, 12 minutes discussion)Moderators: Thomas L. SprayThoralf M. Sundt, III29. Non Operative Thoracic Duct Embolization for TraumaticChylothorax: Experience in 103 patientsMaxim Itkin, John C. Kucharczuk, Scott O. Trerotola, Andrew Kwak,Constantin Cope, Larry R. Kaiser *University of Pennsylvania, Philadelphia, PA, USAInvited Discussant: Nasser K. AltorkiOBJECTIVE: To demonstrate the efficacy of a minimally invasive, non-operativecatheter based approach to the treatment of traumatic chylothoraxMETHODS: A retrospective review of 103 patients (52 male, 51 female, average age59) was conducted to assess the efficacy of thoracic duct (TD) embolization orinterruption for the treatment of high output chyle leak caused by injury to thethoracic duct.RESULTS: Causes of the chyle leak in 103 patients are listed in the Table. 101patients presented with chylothorax (left 46, right 44, bilateral 11), while onepatient had chylopericardium and one had a cervical lymphocele following neckdissection. 17 patients (16%) had previous unsuccessful attempts at thoracic ductligation. In 102/103 patients lymphangiogram was able to be performed successfully.Catheterization of the TD was achieved in 68 (66%) patients. CatheterizationList of the Causes of the Chylous LeaksChest surgery 33Mediastinal surgery 32Cardiac surgery 17Aortic surgery 11Trauma 4Head and Neck 4Spinal surgery 1Radiation 1Total 103* AATS Member152
AMERICAN ASSOCIATION FOR THORACIC SURGERYof the duct is dependent on being able to achieve puncture of the cisterna chyli. In66 of these 68 patients embolization of the TD was performed; in 2 patients it wasnot attempted. Endovascular coils and/or fibrin glue was used to occlude the TD.In 18 of 35 cases where catheterization of the duct was unsuccessful, TD needleinterruption was attempted. Resolution of the chyle leak was observed in 60/66(91%) patients post embolization (3 failed, 2 were lost to follow-up, and 1 diedwithin several days post-procedure from unrelated causes). Needle interruption ofthe TD was successful in 13/18 (72%). patients. In 14 of the 17 patients who hadprevious attempts at TD ligation, embolization or interruption was attempted in14 and was successful in 11 (78%). The overall success rate for the entire series was72% (73/103). There were three minor (3%) complications: 1 asymptomatic embolizationof glue into the pulmonary artery and 2 patients developed transient lowerextremity edema.CONCLUSION: Catheter embolization or needle interruption of the thoracicduct was safe, feasible and successful in eliminating a high output chyle leak in themajority (72%) of cases. This minimally invasive, though technically challenging,procedure should be the initial approach employed for the treatment of a traumaticchylous.TUESDAYMorning153
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AATS FUTURE MEETINGSMay 1-5, 2010Me
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Boston - American Association for Thoracic Surgery

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