Occlusion of thoracic duct stent resulting in recurrent chyluria: role of renal-lymphatic fistula embolization

Tran Quoc Hoa; Nguyen Ngoc Cuong; Le Hoan; Nguyen Hoang; Hoang Long; Doan Tien Luu; Nguyen Cong Hoan

doi:10.1186/s42155-023-00387-6

Occlusion of thoracic duct stent resulting in recurrent chyluria: role of renal-lymphatic fistula embolization

CVIR Endovasc. 2023 Aug 7;6(1):39. doi: 10.1186/s42155-023-00387-6.

Authors

Tran Quoc Hoa^#¹, Nguyen Ngoc Cuong^#^{2

3}, Le Hoan⁴, Nguyen Hoang⁵, Hoang Long¹, Doan Tien Luu⁶, Nguyen Cong Hoan⁷

Affiliations

¹ Surgery Urology, Hanoi Medical University Hospital, Hanoi, Vietnam.
² Radiology Center, Hanoi Medical University Hospital, Hanoi, Vietnam. cuongcdha@gmail.com.
³ Diagnostic Imaging and Interventional Center, Hanoi Medical University Hospital, No1, Ton That Tung, Dong Da, Hanoi, Vietnam. cuongcdha@gmail.com.
⁴ Respiratory Department, Hanoi Medical University, Hanoi, Vietnam.
⁵ Surgery Department, Hanoi Medical University, Hanoi, Vietnam.
⁶ Radiology Center, Hanoi Medical University Hospital, Hanoi, Vietnam.
⁷ Outpatient Department, Hanoi Medical University Hospital, Hanoi, Vietnam.

^# Contributed equally.

Abstract

Background: Thoracic duct (TD) stenting is considered a treatment option for certain pathological conditions caused by TD obstruction, such as chyluria. Several studies have reported on the efficacy of TD stent treatment for both obstructive and leakage condition of TD, but few have evaluated the stent patency. This report aims to describe the patency of TD stent and the effectiveness of renal-lymphatic fistula embolization in the treatment of chyluria.

Case presentation: We report a case of chyluria treated by TD stent previously, stent was placed at the TD venous junction four months before the symptoms recurred. At the second intervention we found the stent was obstructed by debris. We recanalized the stent and successfully catheterised the microcatheter through the stent retrograde into the TD then into the renal-lymphatic fistula branch. After embolization of that abnormal branch, the recurrent chyluria was treated and no further episode of chyluria was occurred during 12 months follow up.

Conclusion: Stent in the TD may be occluded by debris. Embolization of renal-lymphatic fistula might be the most important treatment for spontaneous chyluria.

Keywords: Chyluria; Embolization; Lymphangiography; Occlusion; Stent; Thoracic duct.