Abstract
To compare the clinical effectiveness of thoracic duct embolization using glue and coils compared to ethylene vinyl alcohol. A retrospective review of adult patients who underwent thoracic duct embolization (TDE) between September 2012 and January 2019 was performed. Patient demographics, indications for TDE, etiology of chylous leak, technical details, chest or neck drain output, drain removal date and discharge date were recorded from the electronic medical records. Based on the type of embolic used for TDE, patients were grouped into glue and coil (GC) TDE or ethylene vinyl alcohol (EVOH) TDE. The primary outcome was mean percent change in drain output from 3 days pre-TDE to 3 days post-TDE for each group, and secondary outcomes were mean drain removal interval and mean discharge interval. All outcomes were compared using the two-sample t-test. Seventeen patients with 24 drains (23 chest tubes, 1 neck drain) underwent GC TDE, and 13 patients with 13 drains (11 chest tubes, 1 neck drain, 1 no drain because bronchial casts) underwent EVOH TDE. Mean age was 61 years; 19 were male. Indications for TDE were chylothorax (27/30), cervical lymphatic leak (2/30) and bronchitis plastic (1/30). The etiology of the leak was iatrogenic in 23 patients and non-iatrogenic in 7. Mean percent change in drain output was 57% for GC TDE and 69.9% for EVOH TDE (P = 0.28). Mean drain removal interval was 11.7 days for GC TDE and 11 days for EVOH TDE (P = 0.87). Mean discharge interval was 13.8 days for GC TDE and 17.5 days for EVOH TDE (P = 0.78). This retrospective study suggests that there is no difference in drain output, drain removal interval or patient discharge interval after TDE with coils and glue versus ethylene vinyl alcohol. Therefore, the choice of embolic should be based on operator preference, availability and cost until these results are validated with a randomized trial.
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