Percutaneous transabdominal embolization of thoracic duct lacerations in animals

Abstract

Purpose: To develop percutaneous techniques for lacerating the thoracic duct (TD) and to assess the efficacy of percutaneous TD embolization.

Materials and methods: The TD was catheterized by means of antegrade or antegrade-retrograde techniques after the lymphographically opacified cisterna chyli (CC) was punctured in five swine and one dog. The TD was lacerated by fluid overdistention (n = 1), perforated with stiff guide wires (n = 3) or a 5-F styletted catheter (n = 1), or macerated by rotational guide-wire trauma (n = 1). The TD was percutaneously embolized in five animals with steel (n = 2) and platinum (n = 3) coils. The CC containing a metal target was recatheterized 2-7 days after embolization.

Results: All types of TD trauma led to mediastinal extravasation. The one chylothorax was induced by the 5-F styletted catheter. The TD of four animals was promptly thrombosed with coils. In the fifth animal, the TD failed to thrombose 3 days after embolization, probably because of the use of an undersized platinum are coil. There were no immediate or delayed complications. Necropsy in five animals was unremarkable. The sixth animal was alive and well at 4 months.

Conclusions: Percutaneous transcatheter TD trauma led to mediastinal extravasation in all six animals, but chylothorax occurred in only one animal. TD coil embolization led to duct thrombosis in four of five animals with no early or late complications. The technique has potential clinical applications for localization and selective embolization of TD leaks in debilitated patients.