Abstract No. 729 Thoracic duct externalization

Abstract

Percutaneous thoracic duct (TD) externalization has been utilized for lymphatic decompression of body edema in infants and as part of the staged TD embolization for chylothorax. The aim of this study is to demonstrate technical feasibility of percutaneous TD externalization for both diagnostic and therapeutic purposes. This is a retrospective review of 8 patients (M:F/3:5) who underwent percutaneous TD externalization. Three of 8 (37.5%) patients were infants (range, 5-7 m), 5/8 (62.5%) patients were teens (range, 9-20 y). Indications for TD externalization was non-immune hydrops with anasarca in 3 infants and chylothorax in 5 teenage patients. All 3 infants demonstrated immediate improvement of body wall edema. The chylothorax improved significantly in two of five teenage patients and the TD was embolized in a retrograde manner via the externalized duct. Three of five teenage patients initially displayed short-term worsening of their symptoms after TD externalization. Repeat MR lymphangiography demonstrated stenotic TD in one patient which was successfully dilated with subsequent improvement. The remaining 2 cases demonstrated accessory lymphatic pathways. These patients underwent TD embolization as well as targeted embolization of the accessory lymphatics. Overall, all 8 patients experienced symptomatic improvement. Patients spent an average of 9.9 days with the TD drain (range, 2 to 41 d). Average TD drainage per day was 1367 mL/day (range, 150-4456 mL/day) or 96.5 mL/kg/day. There were no major intra-procedural complications. One patient developed SIRS reaction. We have demonstrated that percutaneous TD externalization is technically safe and provides an effective way to drain TD. The ability to drain the TD can palliate neonates with non-immune hydrops. The ability to temporarily externalize the TD can be used to evaluate the short-term consequences of TD embolization. This technique could be expanded to treat patients with a variety of immune disorders and intravascular congestion such as heart failure. Additionally, it can provide an opportunity for lymphatic fluid sampling.