Transvenous Retrograde Thoracic Ductography: Initial Experience with 13 Consecutive Cases

Purpose To report the feasibility and findings of transvenous retrograde thoracic duct cannulation. Materials and Methods The subjects were 13 patients who had undergone retrograde transvenous thoracic ductography. Despite conservative treatment, all required drainage for chylothorax, chylous ascites, or a chylous pericardial effusion. Lymphangiography was performed, and the junction of the thoracic duct with the vein was identified. A microcatheter was inserted into the thoracic duct retrogradely via the junction with the vein. Results The catheter could be inserted to the cervical part, thoracic part, and cisterna chyli in 12 (92.3%), nine (69.2%), and six (46.2%) patients, respectively. Successful transvenous thoracic ductography was performed in eight patients (61.5%). The cervical part of the thoracic duct was branched into a plexiform configuration beyond which the microcatheter could not be advanced to reach the thoracic part in three unsuccessful cases. The success rate of transvenous thoracic ductography was significantly higher with the simple type (80%) than with the plexiform type (0%; p = 0.035). No extravasation of contrast agent was seen in the eight patients with successful thoracic ductography. Thoracic duct embolization was performed in one patient with a chylous pericardial effusion in whom myriad lymph ducts connecting to the hilar and pericardial regions from the thoracic duct were found, and drainage was unnecessary. Conclusion Transvenous retrograde thoracic ductography was successful in only eight of 13 patients (61.5%), but when the cervical part was the simple type, it was successful in eight of 10 patients (80%).