Thoracic duct embolisation (TDE) is a focused minimally invasive medical procedure aimed at treating refractory
chylothorax, a condition characterised by the accumulation of lymphatic fluid in the pleural space, often due to the
disruption or obstruction of the thoracic duct. It is an effective and less invasive alternative to surgery. Its success in
alleviating symptoms and improving patient outcomes has made it an increasingly preferred option in suitable
cases. The thoracic duct (the largest lymphatic vessel in the body), is responsible for transporting lymph and chyle
from the lower body and left side of the upper body to the venous system.
The indication for TDE arises in patients who have not responded to conservative management of chylothorax,
such as dietary modifications or drainage, and in those for whom surgical intervention poses significant risks.
Common causes of chylothorax include trauma, surgical complications, malignancy, or idiopathic factors.
The procedure of TDE involves the catheterisation of the lymphatic system, usually through the pedal
lymphangiography approach. This is followed by the identification and cannulation of the thoracic duct. Once
accessed, embolising agents, such as coils, glue, or sclerosing agents, are used to occlude the leak in the duct.
The aim is to stop the abnormal flow of lymphatic fluid into the pleural space, thereby allowing the pleural effusion
to resolve and prevent recurrence.
TDE offers several advantages over traditional surgical methods, including reduced morbidity, shorter hospital
stays, and the possibility of performing it under local anesthesia with sedation. Despite its benefits, TDE carries
potential risks and complications, such as lymphatic vessel injury, infection, or non-target embolisation.