title: Percutaneous treatment of thoracic duct injuries.
abstract: BACKGROUND
  Major thoracic or neck surgery or penetrating trauma can cause injury to the thoracic duct and development of a chylothorax. Chylothorax results in metabolic and immunologic disorders that can be life threatening, with a mortality rate reaching 50%. The management of chyle leaks is dependent on the etiology and daily output. Interventions are used to treat only leaks unresponsive to medical management or those with an output exceeding 1,000 ml/day.
  
  
  METHODS
  This study reviewed the existing literature on the percutaneous management of chyle leaks. The authors evaluated five case series and three case reports inclusive of 90 patients in which percutaneous treatment for chylothorax was attempted between 1998 and 2004.
  
  
  RESULTS
  For 71 patients, percutaneous treatment was technically successful, and chylothorax resolved in 49 of the patients (69%). Percutaneous treatment of chylothorax was associated with a 2% morbidity rate and no mortality. For 19 patients whose percutaneous approach failed, either surgical ligation or pleurodesis was performed.
  
  
  CONCLUSIONS
  The percutaneous management of chyle leak is feasible, with low morbidity and mortality rates and a high rate of effectiveness. This approach should be considered before more invasive procedures.
authors.affiliation: Department of Surgery, New York University School of Medicine, New York, NY 10010, USA.
authors.forename: Francesca
authors.initials: F
authors.lastname: Marcon
authors.forename: Katayun
authors.initials: K
authors.lastname: Irani
authors.forename: Theresa
authors.initials: T
authors.lastname: Aquino
authors.forename: John K
authors.initials: JK
authors.lastname: Saunders
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Gouge
authors.forename: Marcovalerio
authors.initials: M
authors.lastname: Melis
mesh_terms: D002404:Catheterization / Q000379:methods; D002916:Chylothorax / Q000178:diet therapy / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D018752:Diet, Fat-Restricted; D004322:Drainage / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods*; D006801:Humans; D008026:Ligation; D019060:Minimally Invasive Surgical Procedures; D018700:Pleurodesis; D011183:Postoperative Complications / Q000178:diet therapy / Q000601:surgery / Q000628:therapy; D013897:Thoracic Duct / Q000293:injuries*; D013907:Thoracostomy; D014947:Wounds and Injuries / Q000150:complications / Q000601:surgery