title: Introduction of lymphangiography and percutaneous embolization of the thoracic duct in a stepwise approach to the management of chylous fistulas.
abstract: BACKGROUND
  Chylous fistula occurring after head and neck or thoracic surgery is an uncommon but well-described complication, with a reported incidence of 1% to 2.5%. Conservative management can be successful and consists of dietary measures combined with suction drainage. This article reports on percutaneous embolization of the thoracic duct through catheterization of the retroperitoneal lymph vessels.
  
  
  METHODS
  Two patients, in whom conservative management for cervical chylous fistula failed, underwent lymphangiography with opacification of the thoracic duct, followed by radioguided catheterization and embolization.
  
  
  RESULTS
  Embolization was successful in both patients. In 1 patient the procedure had to be repeated once to stop the chylous drainage.
  
  
  CONCLUSIONS
  Radioguided percutaneous catheterization and embolization of the retroperitoneal lymph vessels offers an excellent treatment option for patients with persistent chylous fistulas after failure of conservative management. We revised our stepwise management protocol (de Gier, Head Neck 1996; 18:347-351) and now consider this procedure as the secondary intervention step.
authors.affiliation: Department of Head and Neck Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Arnoud T
authors.initials: AT
authors.lastname: van Goor
authors.forename: Robert
authors.initials: R
authors.lastname: Kröger
authors.forename: Houke M
authors.initials: HM
authors.lastname: Klomp
authors.forename: Marianne A A
authors.initials: MA
authors.lastname: de Jong
authors.forename: Michiel W M
authors.initials: MW
authors.lastname: van den Brekel
authors.forename: Alfons J M
authors.initials: AJ
authors.lastname: Balm
mesh_terms: D002913:Chyle; D004621:Embolization, Therapeutic; D005260:Female; D005402:Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D008220:Lymphography; D008875:Middle Aged; D011183:Postoperative Complications; D013897:Thoracic Duct