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Masatoshi Makuuchi - One of the best experts on this subject based on the ideXlab platform.
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Safety and efficacy of Venous Reconstruction in liver resection using cryopreserved homologous veins.
Journal of Hepato-biliary-pancreatic Sciences, 2017Co-Authors: Masaki Yamamoto, Nobuhisa Akamatsu, Akimasa Hayashi, Junichi Togashi, Yoshihiro Sakamoto, Sumihito Tamura, Kiyoshi Hasegawa, Masashi Fukayama, Masatoshi Makuuchi, Norihiro KokudoAbstract:Background Only a few studies have reported the resection and Reconstruction of major hepatic veins during hepatectomy. Here we present our strategy and techniques for Venous Reconstruction with cryopreserved homologous veins, and describe the surgical outcome. Methods Among 2387 hepatectomy patients, 39 patients who required hepatic Venous Reconstruction were reviewed retrospectively. Venous Reconstruction was performed to secure a non-congested liver remnant volume of at least 40% of the total liver volume. Results There was no operative mortality, and the severe morbidity rate was 5% in this series. A total of 41 veins were reconstructed; 30 with homologous veins (73.2%) and 11 with autologous veins (26.8%), with the middle hepatic vein being the most frequent (n=23, 56%). Interposition grafting was performed more often (P=0.003), the length of the Venous resection was longer (P=0.007), and pathologic wall infiltration of the vein was revealed more often (P=0.002) in the homologous graft group than in the autologous graft group. The 1-, 2-, and 3-year overall patency of the reconstructed veins was 55.4%, 46.3%, and 46.3%, respectively. Conclusions Aggressive Venous Reconstruction during hepatectomy using cryopreserved homologous veins is a feasible option with satisfactory short-term outcomes, and may be warranted to improve operative safety. This article is protected by copyright. All rights reserved.
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Venous Reconstruction based on virtual liver resection to avoid congestion in the liver remnant
British Journal of Surgery, 2011Co-Authors: Yoshihiro Mise, Kiyoshi Hasegawa, Masatoshi Makuuchi, Shouichi Satou, Tomonori Aoki, Y. Beck, Yasuhiko Sugawara, Norihiko KokudoAbstract:Background: Hepatic vein (HV) Reconstruction may prevent Venous congestion following resection of liver tumours that encroach on major HVs. This study aimed to identify criteria for Venous Reconstruction based on preoperative evaluation of Venous congestion. Methods: A volumetric analysis using image-processing software was performed in selected patients with liver tumours suspected on preoperative imaging of major HV invasion. The size of the non-congested liver remnant (NCLR) was calculated by subtracting the congested area from the liver remnant. Venous Reconstruction was scheduled in patients who met the following criteria: normal liver function (indocyanine green retention rate at 15 min (ICGR15) of less than 10 per cent) with a NCLR smaller than 40 per cent of total liver volume (TLV), or liver dysfunction (ICGR15 10–20 per cent) with a NCLR smaller than 50 per cent of TLV. Surgical outcomes and liver regeneration were investigated. Results: A total of 55 patients with suspected HV invasion were enrolled. Sacrifice of one or more HVs was deemed possible in 37 patients. Venous Reconstruction was scheduled in 18 patients. At operation, there was seen to be no Venous involvement in 11 patients. The HV was sacrificed in 29 patients, and preserved or reconstructed in 24. Volume restoration ratios at 3 months were similar in the sacrifice (88 per cent) and preserve (87 per cent) groups. Operating time was shorter (465 min) and blood loss was lower (580 ml) in the sacrifice than in the preserve group (523 min and 815 ml respectively). Conclusion: The HV can be sacrificed safely according to the proposed criteria, reducing surgical invasiveness without influencing the postoperative course. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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the technical advance and impact of caudate lobe Venous Reconstruction in left liver additional safety for living related donor liver transplantation
Transplant International, 2010Co-Authors: Shintaro Yamazaki, Tadatoshi Takayama, Masatoshi MakuuchiAbstract:Summary The key to obtaining good overall outcomes in small-for-size liver-graft transplantation is ensuring sufficient blood flow to the graft during the initial period after surgery. In left lobe liver grafting, various Reconstruction techniques have been devised to maximize the limited graft volume. The Reconstructions of the caudate lobe (CL) vessels were one of the main streams. In this article, we focus on the clinical significance of CL vessel Reconstructions after small-for-size liver-graft transplantation and discuss the roles of various techniques. These techniques contribute to the enlargement of the margin of safety with respect to small-for-size liver-graft transplantation.
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one orifice vein Reconstruction in left liver plus caudate lobe grafts
Transplantation, 2007Co-Authors: Takuya Hashimoto, Sumihito Tamura, Yasuhiko Sugawara, Junichi Kaneko, Noboru Motomura, Shinichi Takamoto, Masatoshi MakuuchiAbstract:For maximum use of left liver plus caudate lobe grafts, the short hepatic vein draining the caudate lobe should be reconstructed. We devised a new venoplasty technique. On the graft side, a wide Venous orifice with a long cuff was formed by gathering the left, middle, and short hepatic veins using a conduit vein graft and patch vein grafts. On the recipient side, three hepatic veins were connected to make a wide orifice. The liver graft was then connected to the recipient vena cava with a wide outflow tract and a Venous reservoir. This new technique was adopted in 12 patients and the short-term results of this technique were satisfactory. The present procedure should simplify Venous Reconstruction in the recipient and might be useful to prevent hepatic Venous stenosis resulting from graft regeneration.
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Refinement of Venous Reconstruction using cryopreserved veins in right liver grafts
Liver Transplantation, 2004Co-Authors: Yasuhiko Sugawara, Nobuhisa Akamatsu, Masatoshi Makuuchi, Yoji Kishi, Takashi Niiya, Junichi Kaneko, Hiroshi Imamura, Norihiro KokudoAbstract:Short and direct vein anastomosis is generally performed in living donor liver transplantation using a right liver graft. The graft will regenerate, however, and might thus compress the anastomosis. We formulated a strategy for outflow Reconstruction in right liver graft. When Reconstruction of multiple short hepatic veins was necessary, a cryopreserved inferior vena cava graft was anastomosed with the hepatic veins of the graft in a basin. When there were no major short hepatic veins in the graft, a rectangular-shaped vein graft was used to make a single orifice using the middle and right hepatic veins in the graft. When there were no tributaries of the middle hepatic vein to be reconstructed, a diamond-shaped vein patch was anastomosed on the anterior wall of the right hepatic vein orifice of the graft. These techniques were satisfactorily applied in 40 patients with no torsion or tension at the anastomotic site of the hepatic Venous Reconstruction or other complications in outflow. The present strategy seemed to be technically feasible for outflow Reconstruction in a right liver graft.
Norihiro Kokudo - One of the best experts on this subject based on the ideXlab platform.
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Safety and efficacy of Venous Reconstruction in liver resection using cryopreserved homologous veins.
Journal of Hepato-biliary-pancreatic Sciences, 2017Co-Authors: Masaki Yamamoto, Nobuhisa Akamatsu, Akimasa Hayashi, Junichi Togashi, Yoshihiro Sakamoto, Sumihito Tamura, Kiyoshi Hasegawa, Masashi Fukayama, Masatoshi Makuuchi, Norihiro KokudoAbstract:Background Only a few studies have reported the resection and Reconstruction of major hepatic veins during hepatectomy. Here we present our strategy and techniques for Venous Reconstruction with cryopreserved homologous veins, and describe the surgical outcome. Methods Among 2387 hepatectomy patients, 39 patients who required hepatic Venous Reconstruction were reviewed retrospectively. Venous Reconstruction was performed to secure a non-congested liver remnant volume of at least 40% of the total liver volume. Results There was no operative mortality, and the severe morbidity rate was 5% in this series. A total of 41 veins were reconstructed; 30 with homologous veins (73.2%) and 11 with autologous veins (26.8%), with the middle hepatic vein being the most frequent (n=23, 56%). Interposition grafting was performed more often (P=0.003), the length of the Venous resection was longer (P=0.007), and pathologic wall infiltration of the vein was revealed more often (P=0.002) in the homologous graft group than in the autologous graft group. The 1-, 2-, and 3-year overall patency of the reconstructed veins was 55.4%, 46.3%, and 46.3%, respectively. Conclusions Aggressive Venous Reconstruction during hepatectomy using cryopreserved homologous veins is a feasible option with satisfactory short-term outcomes, and may be warranted to improve operative safety. This article is protected by copyright. All rights reserved.
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safety and efficacy of cryopreserved homologous veins for Venous Reconstruction in pancreatoduodenectomy
Surgery, 2017Co-Authors: Masaki Yamamoto, Nobuhisa Akamatsu, Yoshihiro Sakamoto, Sumihito Tamura, Kiyoshi Hasegawa, Taku Aoki, Norihiro KokudoAbstract:Background There are several techniques for reconstructing the portal vein-superior mesenteric vein during pancreatoduodenectomy. The aim of the present study was to present our results with portal vein-superior mesenteric vein Reconstruction using cryopreserved homologous veins during pancreatoduodenectomy for patients with pancreatic head cancer. Methods Patients who underwent pancreatoduodenectomy for pancreatic head cancer were reviewed retrospectively. In patients with portal vein-superior mesenteric vein resection, the detailed method of Reconstruction and clinical outcomes were reviewed. Clinical characteristics, patient survival, and portal vein-superior mesenteric vein patency were compared between those with and without homologous vein grafts. Factors affecting the patency of reconstructed veins were assessed by univariate analysis. Results Among 144 patients undergoing pancreatoduodenectomy, portal vein-superior mesenteric vein resection was performed in 36 patients (25%); 18 (50%) underwent Reconstruction with homologous veins, and the other 18 (50%) underwent Reconstruction without homologous veins. The extent of portal vein-superior mesenteric vein involvement, operative time, duration of clamping of portal vein-superior mesenteric vein, intraoperative blood loss, and length of the Venous resection were greater ( P ≤ .013 each) in those with homologous vein grafts. There was no significant difference in postoperative morbidity/mortality, patient survival, or portal vein-superior mesenteric vein patency. The 1- and 2-year overall patency of portal vein-superior mesenteric vein was 76% and 71%, respectively, while the 2-year patencies were 67% and 67% in those with homologous veins and 87% and 73% in those without homologous veins without difference between the groups. Circumferential resection and pathologic portal vein-superior mesenteric vein involvement were associated with the patency of the reconstructed vein ( P = .002 and P = .028, resp). Conclusion Use of homologous Venous grafts for portal vein-superior mesenteric vein Reconstruction are feasible alternatives during pancreatoduodenectomy for advanced pancreatic head cancer.
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Refinement of Venous Reconstruction using cryopreserved veins in right liver grafts
Liver Transplantation, 2004Co-Authors: Yasuhiko Sugawara, Nobuhisa Akamatsu, Masatoshi Makuuchi, Yoji Kishi, Takashi Niiya, Junichi Kaneko, Hiroshi Imamura, Norihiro KokudoAbstract:Short and direct vein anastomosis is generally performed in living donor liver transplantation using a right liver graft. The graft will regenerate, however, and might thus compress the anastomosis. We formulated a strategy for outflow Reconstruction in right liver graft. When Reconstruction of multiple short hepatic veins was necessary, a cryopreserved inferior vena cava graft was anastomosed with the hepatic veins of the graft in a basin. When there were no major short hepatic veins in the graft, a rectangular-shaped vein graft was used to make a single orifice using the middle and right hepatic veins in the graft. When there were no tributaries of the middle hepatic vein to be reconstructed, a diamond-shaped vein patch was anastomosed on the anterior wall of the right hepatic vein orifice of the graft. These techniques were satisfactorily applied in 40 patients with no torsion or tension at the anastomotic site of the hepatic Venous Reconstruction or other complications in outflow. The present strategy seemed to be technically feasible for outflow Reconstruction in a right liver graft.
Khashayar Vaziri - One of the best experts on this subject based on the ideXlab platform.
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arterial but not Venous Reconstruction increases 30 day morbidity and mortality in pancreaticoduodenectomy
Journal of Gastrointestinal Surgery, 2020Co-Authors: Sara L. Zettervall, Jeremy L. Holzmacher, Bridget C. Huysman, Gregor Werba, Anton N. Sidawy, Paul P. Lin, Khashayar VaziriAbstract:BACKGROUND Vascular Reconstruction during pancreaticoduodenectomy is increasingly utilized to improve pancreatic cancer resectability. However, few multi-institutional studies have evaluated the morbidity and mortality of arterial and Venous Reconstruction during this procedure. METHODS A retrospective analysis was performed utilizing the targeted pancreas module of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) for pancreaticoduodenectomy from 2014 to 2015. Demographics, comorbidities, and 30-day outcomes for patients who underwent Venous or arterial Reconstruction and both were compared to no Reconstruction. RESULTS A total of 3002 patients were included in our study: 384 with Venous Reconstruction, 52 with arterial, 81 with both, and 2566 without. Compared to patients without Reconstruction, those who underwent Venous Reconstruction had more congestive heart failure (1.8% vs 0.2%, P < 0.01), those with arterial Reconstruction had higher rates of pulmonary disease (11.5% vs. 4.5%, P = 0.02), and neoadjuvant chemotherapy was more common in both Venous (34% vs 12%, P < 0.01) and arterial Reconstruction (21% vs 12%, P = 0.04). In multivariable analysis, there was no increase in morbidity or mortality following Venous Reconstruction. However, arterial Reconstruction was associated with increased 30-day mortality with an odds ratio (OR): 6.7, 95%; confidence interval (CI): 1.8-25. Morbidity was increased as represented with return to the operating room (OR: 4.5, 95%; CI: 1.5-15), pancreatic fistula (OR: 4.4, 95%; CI: 1.7-11), and reintubation (OR: 3.9, 95%; CI: 1.1-14). CONCLUSIONS Venous Reconstruction during pancreaticoduodenectomy does not increase perioperative morbidity or mortality and should be considered for patients previously considered to be unresectable or those where R0 resection would otherwise not be possible due to Venous involvement. Careful consideration should be made prior to arterial Reconstruction given the significant increase in perioperative complications and death within 30 days.
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arterial but not Venous Reconstruction increases 30 day morbidity and mortality in pancreaticoduodenectomy
Journal of Gastrointestinal Surgery, 2020Co-Authors: Sara L. Zettervall, Jeremy L. Holzmacher, Bridget C. Huysman, Gregor Werba, Anton N. Sidawy, Paul P. Lin, Khashayar VaziriAbstract:Vascular Reconstruction during pancreaticoduodenectomy is increasingly utilized to improve pancreatic cancer resectability. However, few multi-institutional studies have evaluated the morbidity and mortality of arterial and Venous Reconstruction during this procedure. A retrospective analysis was performed utilizing the targeted pancreas module of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) for pancreaticoduodenectomy from 2014 to 2015. Demographics, comorbidities, and 30-day outcomes for patients who underwent Venous or arterial Reconstruction and both were compared to no Reconstruction. A total of 3002 patients were included in our study: 384 with Venous Reconstruction, 52 with arterial, 81 with both, and 2566 without. Compared to patients without Reconstruction, those who underwent Venous Reconstruction had more congestive heart failure (1.8% vs 0.2%, P < 0.01), those with arterial Reconstruction had higher rates of pulmonary disease (11.5% vs. 4.5%, P = 0.02), and neoadjuvant chemotherapy was more common in both Venous (34% vs 12%, P < 0.01) and arterial Reconstruction (21% vs 12%, P = 0.04). In multivariable analysis, there was no increase in morbidity or mortality following Venous Reconstruction. However, arterial Reconstruction was associated with increased 30-day mortality with an odds ratio (OR): 6.7, 95%; confidence interval (CI): 1.8–25. Morbidity was increased as represented with return to the operating room (OR: 4.5, 95%; CI: 1.5–15), pancreatic fistula (OR: 4.4, 95%; CI: 1.7–11), and reintubation (OR: 3.9, 95%; CI: 1.1–14). Venous Reconstruction during pancreaticoduodenectomy does not increase perioperative morbidity or mortality and should be considered for patients previously considered to be unresectable or those where R0 resection would otherwise not be possible due to Venous involvement. Careful consideration should be made prior to arterial Reconstruction given the significant increase in perioperative complications and death within 30 days.
Bing Peng - One of the best experts on this subject based on the ideXlab platform.
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laparoscopic pancreaticoduodenectomy with major Venous resection and Reconstruction anterior superior mesenteric artery first approach
Surgical Endoscopy and Other Interventional Techniques, 2018Co-Authors: Yunqiang Cai, Pan Gao, Xin Wang, Bing PengAbstract:Background The en bloc resection of the superior mesenteric or portal vein with concomitant Venous Reconstruction may be required in patients with borderline resectable pancreatic cancer. However, performing laparoscopic pancreaticoduodenectomy (LPD) with major Venous resection and Reconstruction is technically challenging. Herein, we introduced a safe and feasible technique to perform LPD with major Venous resection.
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laparoscopic pancreaticoduodenectomy with major Venous resection and Reconstruction anterior superior mesenteric artery first approach
Surgical Endoscopy and Other Interventional Techniques, 2018Co-Authors: Yunqiang Cai, Pan Gao, Xin Wang, Bing PengAbstract:The en bloc resection of the superior mesenteric or portal vein with concomitant Venous Reconstruction may be required in patients with borderline resectable pancreatic cancer. However, performing laparoscopic pancreaticoduodenectomy (LPD) with major Venous resection and Reconstruction is technically challenging. Herein, we introduced a safe and feasible technique to perform LPD with major Venous resection. Over the period of November 2015 to November 2016, 18 patients underwent laparoscopic pancreaticoduodenectomy with major Venous resection and Reconstruction using the anterior superior mesenteric artery (SMA)-first approach at our institution. Demographic characteristics, intraoperative and postoperative variables, and follow-up outcomes were prospectively collected. Eighteen male and ten female patients were included in this study. The median age of the patients was 58 years (range 49–76 years). Eight cases of wage resections, six cases of end-to-end anastomosis, and four cases of artificial grafts were performed in our series. Only one patient (5.6%) required conversion because of uncontrolled bleeding from the splenic vein. The average operative time was 448 min (range 420–570 min). The mean time for blood occlusion was 32 min, including 17 min for wage resections, 28 min for end-to-end anastomosis, and 48 min for artificial grafts. Thirty-day mortality was not observed in our series. The median postoperative hospital stay was 13 days (range 9–18 days). Three patients suffered from pancreatic fistula (Grade A), and one suffered from abdominal bleeding after subcutaneous injection with low-molecular heparin. In this case, abdominal bleeding was stopped through conservative therapies. Laparoscopic pancreaticoduodenectomy with major Venous resection and Reconstruction can be safely and feasibly performed. The anterior SMA-first approach can facilitate this procedure and decrease operative time and blood occlusion duration.
Ravi N. Srinivasa - One of the best experts on this subject based on the ideXlab platform.
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stent placement across the renal vein inflow in patients undergoing Venous Reconstruction preserves renal function and renal vein patency experience in 93 patients
Journal of Endovascular Therapy, 2019Co-Authors: Jeffrey Forris Beecham Chick, Anthony N. Hage, Joseph J. Gemmete, Ravi N. Srinivasa, Jacob J Bundy, Charles Brewerton, Jordan Fenlon, Steven D Abramowitz, Dawn M Coleman, David M WilliamsAbstract:Purpose To determine if stent placement across the renal vein inflow affects kidney function and renal vein patency. Methods Between June 2008 and September 2016, 93 patients (mean age 39 years, range 15-70; 54 women) with iliocaval occlusion underwent Venous stent placement and were retrospectively reviewed. For this analysis, the patients were separated into treatment and control groups: 51 (55%) patients had suprarenal and infrarenal iliocaval Venous disease requiring inferior vena cava stent Reconstruction across the renal vein inflow (treatment group) and 42 (45%) patients had iliac vein stenting sparing the renal veins (control group). Treatment group patients received Wallstents (n=15), Gianturco Z-stents (n=24), or suprarenal and infrarenal Wallstents such that the renal veins were bracketed with a "renal gap" (n=12). Stenting technical success, stent type, glomerular filtration rate (GFR), and creatinine before and after stent placement were recorded, along with renal vein patency and complications. Results All procedures were technically successful. In the 51-patient treatment group, 15 (29%) patients received Wallstents and 24 (47%) received Gianturco Z-stents across the renal veins, while 12 (24%) were given a "renal gap" with no stent placement directly across the renal vein inflow. In the control group, 42 patients received iliac vein Wallstents only. Mean prestent GFR was 59±1.8 mL/min/1.73 m2 and mean prestent creatinine was 0.8±0.2 mg/dL for the entire cohort. Mean prestent GFR and creatinine values in the Wallstent, Gianturco Z-stent, and "renal gap" subgroups did not differ from the iliac vein stent group. Mean poststent GFR and creatinine values were 59±3.3 mL/min/1.73 m2 and 0.8±0.3 mg/dL, respectively. There were no differences between mean pre- and poststent GFR (p=0.32) or creatinine (p=0.41) values when considering all patients or when comparing the treatment subgroups and the control group. There were no differences in the poststent mean GFR or creatinine values between the Wallstent (p=0.21 and p=0.34, respectively) and Gianturco Z-stent (p=0.43 and p=0.41, respectively) groups and the "renal gap" group. One patient with a Wallstent across the renal veins developed right renal vein thrombosis 7 days after the procedure. Conclusion Stent placement across the renal vein inflow did not compromise renal function. A very small risk of renal vein thrombosis was seen.
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stent placement across the renal vein inflow in patients undergoing Venous Reconstruction preserves renal function and renal vein patency experience in 93 patients
Journal of Endovascular Therapy, 2019Co-Authors: Jeffrey Forris Beecham Chick, Anthony N. Hage, Joseph J. Gemmete, Ravi N. Srinivasa, Jacob J Bundy, Charles Brewerton, Jordan Fenlon, Steven D Abramowitz, Dawn M Coleman, David M WilliamsAbstract:Purpose: To determine if stent placement across the renal vein inflow affects kidney function and renal vein patency. Methods: Between June 2008 and September 2016, 93 patients (mean age 39 years, ...
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Chylothorax secondary to Venous outflow obstruction treated with transcervical retrograde thoracic duct cannulation with embolization and Venous Reconstruction
Journal of Vascular Surgery Cases and Innovative Techniques, 2018Co-Authors: Jeffrey Forris Beecham Chick, Anthony N. Hage, Nishant Patel, Joseph J. Gemmete, J. Matthew Meadows, Ravi N. SrinivasaAbstract:Abstract A chylothorax may be due to either direct trauma or occlusion of the thoracic duct. Treatments include antegrade or retrograde glue and coil embolization as well as thoracic duct stent graft placement. This report describes a patient with chylothorax secondary to Venous outflow occlusion. Left upper extremity venography demonstrated multifocal left brachiocephalic and axillary vein occlusions with retrograde filling of an engorged and disrupted thoracic duct. Retrograde thoracic duct lymphangiography with embolization and left upper extremity Venous Reconstruction were performed with complete resolution of chylothorax.
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Chylothorax secondary to Venous outflow obstruction treated with transcervical retrograde thoracic duct cannulation with embolization and Venous Reconstruction
Elsevier, 2018Co-Authors: Jeffrey Forris Beecham Chick, Md, Mph Dabr, Bs ,anthony N. Hage, Nishant Patel, Md Mba, Joseph Gemmete, Md J. Fsir, Matthew J. Meadows, Ravi N. SrinivasaAbstract:A chylothorax may be due to either direct trauma or occlusion of the thoracic duct. Treatments include antegrade or retrograde glue and coil embolization as well as thoracic duct stent graft placement. This report describes a patient with chylothorax secondary to Venous outflow occlusion. Left upper extremity venography demonstrated multifocal left brachiocephalic and axillary vein occlusions with retrograde filling of an engorged and disrupted thoracic duct. Retrograde thoracic duct lymphangiography with embolization and left upper extremity Venous Reconstruction were performed with complete resolution of chylothorax. Keywords: Chylothorax, Central Venous occlusion, Retrograde, Thoracic duct, Embolization, Venous reconstructio
