Thoracic Duct Embolization: Analysis of Practice Patterns

Abstract

Thoracic duct embolization (TDE) has become the standard treatment for atraumatic and traumatic chylothoraces. Numerous approaches to embolization including intranodal lymphangiography, transabdominal, and retrograde catheterization of the thoracic duct have become the preferred methods for the treatment of chyle leaks. The purpose of this study was to determine training, treatment techniques, outcomes, and practice patterns of practitioners performing TDE. From September to October of 2017, a 34-question survey focusing on training, treatment techniques, outcomes, and practice patterns of TDE was distributed through the Open Forum of the Society of Interventional Radiology Connect website. Fifty-four practitioners completed the entire survey. Percentages were calculated for answers to the questions. Chi-squared analysis was performed, comparing data from academic center respondents, private practice settings, and hybrid practice settings. P values<0.5 were considered statistically significant. All responses were from interventional radiologists. Forty-seven practitioners (87.0%) performed TDE in the United States, and 1 performed (1.9%) abroad; 6 practitioners (11.1%) did not perform TDE. Of all, 88.9% (n=48) performed TDE in academic (n=24; 50%), private (n=17; 35.4%), or hybrid (n=6; 12.5%) practice settings. For diagnostic lymphangiography, 100% (n=48) performed intranodal pelvic lymphangiography. A 25-gauge needle was used by 77.1% (n=37) to access pelvic lymph nodes, and most (83.3%; n=40) reported using manual hand injection to administer ethiodized oil. Nine of 24 (37.5%) respondents in academic practice and 15 of 23 (65.2%) in private practice were successful in cannulating the thoracic duct >80% of the time. Most referrals were from thoracic surgery (n=47; 97.9%). TDE is performed by practitioners in both academic and private practice settings. Treatment techniques were similar for a majority of operators. Technical success rates were higher in private practice. Most referrals were from thoracic surgery.