Outcomes of Intranodal and Modified Intranodal Lymphangiography for Treatment of Traumatic Chylous Leaks in the Thorax and Neck

Rupal Parikh; Elisabeth R Seyferth; Sanjay Palat; Maxim Itkin; Gregory J Nadolski

doi:10.1007/s00270-024-03900-z

Outcomes of Intranodal and Modified Intranodal Lymphangiography for Treatment of Traumatic Chylous Leaks in the Thorax and Neck

Cardiovasc Intervent Radiol. 2024 Dec 10. doi: 10.1007/s00270-024-03900-z. Online ahead of print.

Authors

Rupal Parikh¹, Elisabeth R Seyferth², Sanjay Palat³, Maxim Itkin², Gregory J Nadolski²

Affiliations

¹ Division of Interventional Radiology, Department of Radiology, University of California San Diego School of Medicine, San Diego, CA, 92037, USA. ruparikh@health.ucsd.edu.
² Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
³ Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.

PMID: 39658750
DOI: 10.1007/s00270-024-03900-z

Abstract

Purpose: To report outcomes, procedure and fluoroscopy times, and adverse event rates after intranodal lymphangiography (IL) and modified IL (mIL) for treatment of traumatic chylous leaks in the thorax and neck.

Methods: Under an IRB-approved protocol, retrospective review of a quality assurance database identified all lymphangiograms for post-surgical refractory chylous leaks in the thorax and neck at a tertiary center from 2002-2022. Records were reviewed for technical and clinical outcomes, procedure and fluoroscopy times, and adverse events. Pedal lymphangiograms were excluded. Patients were categorized into IL (pre-2016) and mIL (post-2016) cohorts. mIL incorporated pneumatic calf compression throughout the procedure. Technical success was defined as successful thoracic duct cannulation. Clinical success was defined as leak resolution and eventual chest or other drain removal within 2 weeks post-procedure. A two-tailed Fischer's exact test was used to compare categorical outcomes. A two-tailed t test was used to compare means.

Results: Two hundred and thirty-nine patients underwent 263 thoracic duct embolizations of traumatic chylous leaks in the thorax/neck. Intranodal lymphangiography was used in 167 cases in 150 patients. Overall clinical success was 94.6% [n = 142/150]. Technical success was higher in mIL (94.2% [81/86]) than IL (76.5% [62/81]) (p = 0.002). Clinical success per patient and procedure were similar between cohorts (92.3% [72/78] mIL versus 97.2% [70/72] IL, p = 0.27, and 83.7% [72/86] mIL versus 85.1% [69/81] IL, p = 0.83, respectively). Mean procedure time in mIL (83.4 ± 31.9 min) was shorter than in IL (119.2 ± 45.9 min) (p < 0.0001). Mean fluoroscopy time in mIL (33.8 ± 17.3 min) was shorter than in IL (41.7 ± 23.2 min) (p = 0.02). Adverse event rate was not significantly different between groups.

Conclusion: Overall, thoracic duct embolization for traumatic chylothorax has high clinical success, approaching 95%. While clinical success of mIL was similar to IL, technical success and mean procedure and fluoroscopic times were significantly improved. Findings suggest modified intranodal lymphangiography should be utilized to treat traumatic chylothorax.

Level of evidence: Level 4, Case Series.

Keywords: Chylothorax; Chylous leak; Intra-nodal lymphangiography; Lymphangiography; TDE; Thoracic duct embolization.