Introduction of lymphangiography and percutaneous embolization of the thoracic duct in a stepwise approach to the management of chylous fistulas

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.