title: Percutaneous embolization of thoracic duct injury post-esophagectomy should be considered initial treatment for chylothorax before proceeding with open re-exploration.
abstract: BACKGROUND
  Post-esophagectomy patients who develop high-output chylous fistula and chylothorax can be successfully treated with percutaneous ablation thereby avoiding reoperation.
  
  
  METHODS
  Five patients with refractory chylous fistula post-esophagectomy were treated with percutaneous embolization. Fistula outputs, evaluation of lymphatic access sites, agents used and additional procedures were analyzed.
  
  
  RESULTS
  Successful ablation of the chylous fistula was achieved in 4 of the 5 (80%) patients. Pretreatment chylous output averaged 1,756 mL/day. Cumulative chylous output (resection to ablation) averaged 28 L/patient. A modified technique is detailed, which utilizes direct puncture of groin lymph nodes to facilitate opacification of the thoracic duct.
  
  
  CONCLUSIONS
  Percutaneous embolization strategies to treat chylothorax should be considered initial therapy before reoperation and direct ligation. Opacification of the thoracic duct to facilitate direct transhepatic cannulation can be accomplished with direct lymph node cannulation in the groin. Successful ablation of chylothorax following percutaneous embolization is predictable in a high percentage of cases.
authors.affiliation: Exempla Saint Joseph Hospital, Department of Graduate Medical Education, General Surgery, Denver, CO, USA. Electronic address: Kyle.Marthaller@sclhs.net.
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Marthaller
authors.affiliation: Colorado Permanente Medical Group, Department of Vascular Therapy, Denver, CO, USA.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Johnson
authors.affiliation: University of Central Florida College of Medicine, Orlando, FL, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Pride
authors.affiliation: Exempla Saint Joseph Hospital, Department of Graduate Medical Education, General Surgery, Denver, CO, USA.
authors.forename: Erick R
authors.initials: ER
authors.lastname: Ratzer
authors.affiliation: Exempla Saint Joseph Hospital, Department of Graduate Medical Education, General Surgery, Denver, CO, USA.
authors.forename: Harris W
authors.initials: HW
authors.lastname: Hollis
mesh_terms: D000368:Aged; D002916:Chylothorax / Q000628:therapy*; D004121:Dimethyl Sulfoxide / Q000627:therapeutic use; D004621:Embolization, Therapeutic / Q000379:methods*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D011145:Polyvinyls / Q000627:therapeutic use; D011183:Postoperative Complications / Q000628:therapy*; D012086:Reoperation; D012189:Retrospective Studies; D013897:Thoracic Duct / Q000293:injuries*; D016896:Treatment Outcome
chemical_list: C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide
keywords: Chylothorax; Coil embolization; Onyx (cyanoacrylates); Postesophagectomy chylothorax; Thoracic duct; Thoracic duct disruption