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Lymphatic conduction disorders, including chylothorax and plastic bronchitis, are often complex and associated with morbidity. Interventional techniques, including thoracic duct embolization (TDE) and selective lymphatic embolization, are increasingly used in the management of these disorders. We present our experience with TDE for these disorders in children with focus on outcomes. Clinical and lymphangiogram records of 104 patients (67 males; median age 6.2 y, IQR 8.8 y; median weight 17.8 kg, IQR 18.6 kg) who underwent TDE for thoracic lymphatic conduction disorders from 2009 to 2021 were analyzed; 53 patients presented with chylothorax and 56 with plastic bronchitis (5 patients had both). Relevant clinical and imaging data, including technical aspects of the procedure, complications, and outcomes, were collated. Etiology of conduction disorders was palliation of single-ventricle heart disease and Glenn/Fontan shunt in 89 patients (86%), other congenital heart disease in 3 (3%), and primary conduction anomaly (i.e., generalized lymphatic anomaly, central conducting lymphatic anomaly, Gorham-Stout disease, and Kaposiform lymphangiomatosis) in 12 (12%). Antegrade access of the thoracic duct with subsequent glue embolization was performed in all patients. Median inpatient stay after procedure was 7 days (IQR 8 d). Procedure-related adverse events included sepsis/systemic inflammatory response syndrome in 3 patients (3%), intra-abdominal bleeding in 3 patients (3%), transient hypotension in 2 (2%), cerebral embolization in 2 (2%), and cardiac arrest in 1 (1%). Median follow-up was 24 months (IQR 40 m). Presenting symptoms were resolved in 82 (79%), improved in 3 patients (3%) and unresolved in 19 patients (18%). New symptoms (e.g., ascites, protein losing enteropathy) developed in 10 of the overall 104 patients (10%). While TDE improved or resolved presenting symptoms in most patients, a substantial fraction had persistent or new symptoms of lymphatic conduction disorder. Selective lymphatic embolization, while maintaining patency of the thoracic duct, may warrant additional consideration in planning lymphatic intervention.
Srinivasan et al. (Wed,) studied this question.