Indications

• High volume chylothorax or recurrent lymphocele in the neck (>1L/day) PLUS failure of conservative tx (low fat diet, TPN, chest tube).

• Characterize lymphatic fistulas as well as intervene on leaks

• Less invasive option compared to surgical intervention.

Contraindications

• Pseudo-chylous effusion (caused by TB or rheumatoid dz)

  • • Cholesterol-dominant fluid with triglycerides < 50 and no chylomicrons

• Leak responsive to conservative measures

• Low ligation of thoracic duct

• Contrast or lipiodol allergy that cannot be premedicated

• Pulmonary insufficiency OR right-to-left shunt, given potential for nontarget embolization

• Uncorrectable coagulopathy

Imaging Review

• Review prior cross-sectional imaging to evaluate lymphatic system as well as groin lymph nodes for access.

• Identify location of the aorta relative to the spine at T12-L2 (where we may be crossing into cisterna chyli transabdominally).

Tips for Workup

• Pertinent hx: Suspected etiology of leak? Recent surgery? Prior therapy and response?

• Moderate sedation often adequate for analgesia, but due to length of procedure, Anesthesia sometimes necessary.

• Consent:

  • • Embolization of oil to lungs (common but typically asymptomatic) or potentially paradoxical embolization, other nontarget embolization with coils or glue, hemorrhage, infection, pancreatitis (rare)