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Jeffrey Forris Beecham Chick - One of the best experts on this subject based on the ideXlab platform.
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vascular and lymphatic complications after Thoracic Duct cannulation
Journal of vascular surgery. Venous and lymphatic disorders, 2018Co-Authors: Jacob J Bundy, Ravi N. Srinivasa, Rajiv N Srinivasa, Joseph J Gemmete, Anthony N Hage, Jeffrey Forris Beecham ChickAbstract:Abstract Objective The objective of this study was to determine the incidence of vascular and lymphatic complications after attempted transabdominal Thoracic Duct cannulation. Methods There were 58 patients who underwent attempted Thoracic Duct cannulation. Patients presented with chyle leak in the chest (n = 40), abdomen (n = 9), neck (n = 8), and pelvis (n = 1). Vertebral body level and geographic access, needle gauge, additional access for treatment, technical success, intervention performed, immediate and delayed complications, and follow-up duration were recorded. Imaging and electronic medical records were reviewed at follow-up for complications and treatment success. Results Access into the lymphatic system was obtained at L1 (n = 21), T12 (n = 17), L2 (n = 14), L3 (n = 3), T11 (n = 1), L4 (n = 1), and L5 (n = 1). Lymphatic access was achieved in the center (n = 28), on the right (n = 16), or on the left (n = 14) of the vertebral body; 21-, 22-, and 25-gauge needles were used in 45 patients, 12 patients, and 1 patient, respectively. Arm venous and percutaneous supraclavicular access was successful in 15 patients and eight patients, respectively. Cannulation of the Thoracic Duct was achieved in 52 (89.7%) patients. Embolization, disruption, and stenting were performed in 41 (70.7%), 12 (20.7%), and 2 (3.4%) patients; 3 (5.2%) patients had normal Thoracic Ducts after successful cannulation. Immediate complications consisted of shearing of the access wire in two (3.4%) patients. Retrospective analysis of initial follow-up imaging in 49 (84.5%) patients revealed the following late complications: inferior vena cava and right renal vein thrombosis and one perinephric lymphatic collection. Conclusions Of 58 patients who had attempted Thoracic Duct cannulation, successful access was achieved in 90% of patients. Early and delayed complications occurred in 3.4% and 4% of patients, respectively. Thoracic Duct cannulation represents a highly successful technique that aids in the treatment of chyle leaks in medically complex patients.
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Pediatric lymphangiography, Thoracic Duct embolization and Thoracic Duct disruption: a single-institution experience in 11 children with chylothorax
Pediatric Radiology, 2018Co-Authors: Bill S. Majdalany, Jeffrey Forris Beecham Chick, Wael A. Saad, Minhaj S. Khaja, Kyle J. Cooper, Ravi N. SrinivasaAbstract:Background Interventional radiology treatment of chylothorax is well described in adults, with high technical and clinical success that decreases patient morbidity and mortality. However there is limited experience in children. Objective To report the technical and clinical success of lymphangiography, Thoracic Duct embolization and Thoracic Duct disruption in the pediatric population. Materials and methods We studied 11 pediatric patients (7 boys, 4 girls; median weight 6.0 kg) who underwent lymphangiography and Thoracic Duct embolization from November 2015 to May 2017. All 11 (100%) children presented with chylothorax, with 1 (9%) having concomitant chylous ascites and 1 (9%) having concomitant chylopericardium. Ten (91%) children had traumatic chylothorax and one (9%) had congenital chylothorax. We recorded technical success, clinical success and complications. Results Twelve procedures were completed in 11 children. Bilateral intranodal lymphangiography was technically successful in all (100%) patients. Central lymphatics were visualized in eight (67%) procedures. Access to central lymphatics was attempted in eight procedures and successful in five (63%). In three (37%) of the eight procedures, disruption was performed when the central lymphatics could not be accessed. Clinical success was achieved in 7/11 (64%) children. Three minor complications were reported. No major complications were encountered. Conclusion Lymphangiography, Thoracic Duct embolization and Thoracic Duct disruption are successful interventional strategies in children with chylothorax and should be considered as viable treatment options at any age.
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the Thoracic Duct clinical importance anatomic variation imaging and embolization
European Radiology, 2016Co-Authors: Oren W. Johnson, Michael S. Stecker, Nikunj Rashmikant Chauhan, Jeffrey Forris Beecham Chick, Alexandra Holmsen Fairchild, Timothy P. Killoran, Alisa SuzukihanAbstract:The Thoracic Duct is the body’s largest lymphatic conduit, draining upwards of 75 % of lymphatic fluid and extending from the cisterna chyli to the left jugulovenous angle. While a typical course has been described, it is estimated that it is present in only 40-60% of patients, often complicating already challenging interventional procedures. The lengthy course predisposes the Thoracic Duct to injury from a variety of iatrogenic disruptions, as well as spontaneous benign and malignant lymphatic obstructions and idiopathic causes. Disruption of the Thoracic Duct frequently results in chylothoraces, which subsequently cause an immunocompromised state, contribute to nutritional depletion, and impair respiratory function. Although conservative dietary treatments exist, the majority of Thoracic Duct disruptions require embolization in the interventional suite. This article provides a comprehensive review of the clinical importance of the Thoracic Duct, relevant anatomic variants, imaging, and embolization techniques for both diagnostic and interventional radiologists as well as for the general medical practitioner. • Describe clinical importance, embryologic origin, and typical course of the Thoracic Duct. • Depict common/lesser-known Thoracic Duct anatomic variants and discuss their clinical significance. • Outline the common causes of Thoracic Duct injury and indications for embolization. • Review the Thoracic Duct embolization procedure including both pedal and intranodal approaches. • Present and illustrate the success rates and complications associated with the procedure.
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The Thoracic Duct: clinical importance, anatomic variation, imaging, and embolization
European Radiology, 2016Co-Authors: Oren W. Johnson, Michael S. Stecker, Nikunj Rashmikant Chauhan, Jeffrey Forris Beecham Chick, Alexandra Holmsen Fairchild, Chieh-min Fan, Timothy P. Killoran, Alisa Suzuki-hanAbstract:The Thoracic Duct is the body’s largest lymphatic conduit, draining upwards of 75 % of lymphatic fluid and extending from the cisterna chyli to the left jugulovenous angle. While a typical course has been described, it is estimated that it is present in only 40-60% of patients, often complicating already challenging interventional procedures. The lengthy course predisposes the Thoracic Duct to injury from a variety of iatrogenic disruptions, as well as spontaneous benign and malignant lymphatic obstructions and idiopathic causes. Disruption of the Thoracic Duct frequently results in chylothoraces, which subsequently cause an immunocompromised state, contribute to nutritional depletion, and impair respiratory function. Although conservative dietary treatments exist, the majority of Thoracic Duct disruptions require embolization in the interventional suite. This article provides a comprehensive review of the clinical importance of the Thoracic Duct, relevant anatomic variants, imaging, and embolization techniques for both diagnostic and interventional radiologists as well as for the general medical practitioner. Key Points • Describe clinical importance, embryologic origin, and typical course of the Thoracic Duct . • Depict common/lesser-known Thoracic Duct anatomic variants and discuss their clinical significance . • Outline the common causes of Thoracic Duct injury and indications for embolization . • Review the Thoracic Duct embolization procedure including both pedal and intranodal approaches . • Present and illustrate the success rates and complications associated with the procedure .
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Imaging and Embolization: Illustration of Variable Thoracic Duct Anatomy for Thoracic Duct Embolization Pre-Procedure Planning
2015Co-Authors: Nikunj Rashmikant Chauhan, Jeffrey Forris Beecham Chick, Alisa HanAbstract:Poster: "ECR 2015 / C-1455 / Imaging and Embolization: Illustration of Variable Thoracic Duct Anatomy for Thoracic Duct Embolization Pre-Procedure Planning " by: " N. Chauhan , J. F. B. Chick, A. Han; Boston, MA/US"
Terry W. Pinson - One of the best experts on this subject based on the ideXlab platform.
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Thoracoscopic ligation of the Thoracic Duct.
Surgical endoscopy, 1993Co-Authors: Raleigh B. Kent, Terry W. PinsonAbstract:Traditional operative management for chylous drainage refractory to conservative therapy is Thoracic Duct ligation via right open thoracotomy. This case report details successful thoracoscopic ligation of the Thoracic Duct for a chylous leak following a left neck dissection. Since the thoracoscopic approach is less morbid than open thoracotomy, early operative management is recommended for Thoracic Duct injuries.
Hiroshi Takita - One of the best experts on this subject based on the ideXlab platform.
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Inhibition of mixed lymphocyte reaction by Thoracic Duct lymph: removal of inhibitory effect by Thoracic Duct drainage in lung cancer.
Journal of Surgical Oncology, 2006Co-Authors: Hiroshi TakitaAbstract:: The inhibitory effect of the Thoracic Duct lymph of a patient with lung cancer on the "one-way" mixed lymphocyte reaction without cytoxicity is unequivocally demonstrated. The effect seems to be dose related. A moderate inhibition of mixed lymphocyte reaction is still observed, even if the responding cells are preincubated in the Thoracic Duct lymph for 1 hr only prior to the addition of stimulating cells. The inhibitory effect of Thoracic Duct lymph on the mixed lymphocyte reaction is no longer evident when the material is added 1-4 days after the beginning of culture. These observations suggest that the mechanism of the inhibitory effect of Thoracic Duct lymph may be a simple attachment of inhibitory factors to the receptor sites on the responding lymphocytes, causing interference in cell to cell interaction. The inhibitory effect of Thoracic Duct lymph collected 1 week after the Thoracic Duct drainage on mixed lymphocyte reaction is significantly lower than that of Thoracic Duct lymph collected at the beginning of the procedure. This indicates that the blocking effect of Thoracic Duct lymph can be easily removed by this technique; which is technically feasible in man. The interrelationship of the tumor-specific blocking factor, Thoracic Duct drainage, and tumor growth pattern are discussed with respect to the potential usefulness of this procedure as adjuvant immunotherapy in the management of patients with neoplastic diseases.
Maxim Itkin - One of the best experts on this subject based on the ideXlab platform.
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feasibility of ultrasound guided intranodal lymphangiogram for Thoracic Duct embolization
Journal of Vascular and Interventional Radiology, 2012Co-Authors: G Nadolski, Maxim ItkinAbstract:Abstract Purpose To show the feasibility of opacifying the Thoracic Duct using ultrasound-guided intranodal lymphangiogram (IL) for Thoracic Duct embolization (TDE). Materials and Methods Six patients (two women and four men, mean age, 59.2 y [range, 43–74 y]) underwent IL and TDE for chylothorax. Under ultrasound guidance, a needle was positioned in a groin lymph node, and lipiodol was injected. The Thoracic Duct was catheterized, and embolization was performed as indicated. Cumulative times from start of the procedure until initiation of the lymphangiogram, until identification of target lymphatic, until catheterization of the Thoracic Duct, and until completion of the procedure were collected. Times were compared with times of a control group of six patients (two women and four men, mean age, 66.7 y [range, 49–82 y]) who had undergone TDE using pedal lymphangiography (PL). Results The procedure of opacification, catheterization, and embolization of the Thoracic Duct was successful in all cases. Cumulative times (mean ± standard deviation) in the IL and PL groups from start of the procedure until ( i ) initial lymphangiogram were 20.5 minutes ± 8.6 and 46.5 minutes ± 22.6, ( ii ) identification of a target lymphatic for catheterization were 60.5 minutes ± 18.2 and 110.5 minutes ± 31.6, ( iii ) catheterization of the Thoracic Duct were 79.0 minutes ± 28.9 and 128.2 minutes ± 37.0, and ( iv ) completion of procedure were 125.8 minutes ± 49.0 and 152.8 minutes ± 36.4. Conclusions IL is a feasible technique to visualize the Thoracic Duct for embolization. Using IL, the Thoracic Duct may be more quickly visualized and catheterized for TDE than with PL.
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Thoracic Duct embolization.
Seminars in Interventional Radiology, 2011Co-Authors: Maxim Itkin, Eric H. ChenAbstract:Percutaneous treatment of chylothorax was developed as a minimally invasive alternative to surgical options. The treatment consists of diagnostic pedal lymphangiography followed by transabdominal catheterization of the cisterna chyli (CC)/Thoracic Duct (TD) and embolization of the TD proximal to the chyle leak. Initially developed by Cope et al,1 Thoracic Duct embolization (TDE) has become a viable primary treatment for chylous leaks. Potential advantages include the minimally invasive nature of the procedure, which results in reDuction of mortality and morbidity, as well as the ability to identify chyle leaks and variations in TD Duct anatomy.2
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Thoracic Duct embolization for nontraumatic chylous effusion experience in 34 patients
Chest, 2010Co-Authors: G Nadolski, Maxim ItkinAbstract:Background Thoracic Duct embolization (TDE) is an acceptable alternative procedure for treating traumatic chylothorax. The purpose of this study is to demonstrate efficacy of TDE in treating nontraumatic chylous effusions. Methods A retrospective review of 34 patients was conDucted assessing technical and clinical success of TDE for nontraumatic chylous effusions. Results Thirty-four patients (mean age, 59 years; 27 female patients) with nontraumatic chylous effusions underwent TDE. Presentations included 21 unilateral chylothoraces (61.8%), nine bilateral chylothoraces (26.5%), two isolated chylopericardiums (5.9%), and two pleural effusions with chylopericardium (5.9%). TDE was technically successful in 24 of 34 patients (70.6%). The Thoracic Duct could not be catheterized in four of 34 (11.8%). Cisterna chyli was not visualized in six of 34 patients (17.6%), and, thus, TDE was not attempted. Follow-up was available for 32 patients. Four lymphangiographic patterns were observed: (1) normal Thoracic Duct in 17.6% of patients (six of 34), (2) occlusion of Thoracic Duct in 58.8% (20 of 34), (3) failure to opacify Thoracic Duct in 17.6% (six of 34), and (4) extravasation of chyle in 5.9% (two of 34). Clinical success varied with the lymphangiographic pattern. The clinical success rate was 16% (one of six) in cases of normal Thoracic Duct, 75% (15 of 20 patients) in occlusions of the Thoracic Duct, 16% (one of six) in cases of failure to opacify the Thoracic Duct, and 50% in two cases of chyle extravasation. Lymphangiography alone cured two patients (6.5%). Conclusion TDE was most successful in cases of Thoracic Duct occlusion and extravasation. Lymphangiography is important for identifying the cause of chylous effusions and selecting patients who benefit most from TDE.
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nonoperative Thoracic Duct embolization for traumatic Thoracic Duct leak experience in 109 patients
The Journal of Thoracic and Cardiovascular Surgery, 2010Co-Authors: Maxim Itkin, John C Kucharczuk, Andrew Kwak, Scott O Trerotola, Larry R KaiserAbstract:Objective To demonstrate the efficacy of a minimally invasive, nonoperative, catheter-based approach to the treatment of traumatic chyle leak. Methods A retrospective review of 109 patients was conDucted to assess the efficacy of Thoracic Duct embolization or interruption for the treatment of high-output chyle leak caused by injury to the Thoracic Duct. Results A total of 106 patients presented with chylothorax, 1 patient presented with chylopericardium, and 2 patients presented with cervical lymphocele. Twenty patients (18%) had previous failed Thoracic Duct ligation. In 108 of 109 patients, a lymphangiogram was successful. Catheterization of the Thoracic Duct was achieved in 73 patients (67%). In 71 of these 73 patients, embolization of the Thoracic Duct was performed. Endovascular coils or liquid embolic agent was used to occlude the Thoracic Duct. In 18 of 33 cases of unsuccessful catheterization, Thoracic Duct needle interruption was attempted below the diaphragm. Resolution of the chyle leak was observed in 64 of 71 patients (90%) post-embolization. Needle interruption of the Thoracic Duct was successful in 13 of 18 patients (72%). In 17 of the 20 patients who had previous attempts at Thoracic Duct ligation, embolization or interruption was attempted and successful in 15 (88%). The overall success rate for the entire series was 71% (77/109). There were 3 (3%) minor complications. Conclusion Catheter embolization or needle interruption of the Thoracic Duct is safe, feasible, and successful in eliminating a high-output chyle leak in the majority (71%) of patients. This minimally invasive, although technically challenging, procedure should be the initial approach for the treatment of a traumatic chylothorax.
Raleigh B. Kent - One of the best experts on this subject based on the ideXlab platform.
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Thoracoscopic ligation of the Thoracic Duct.
Surgical endoscopy, 1993Co-Authors: Raleigh B. Kent, Terry W. PinsonAbstract:Traditional operative management for chylous drainage refractory to conservative therapy is Thoracic Duct ligation via right open thoracotomy. This case report details successful thoracoscopic ligation of the Thoracic Duct for a chylous leak following a left neck dissection. Since the thoracoscopic approach is less morbid than open thoracotomy, early operative management is recommended for Thoracic Duct injuries.
