Open AccessTHORACIC DUCT STENT-GRAFT DECOMPRESSION WITH 3-MONTH PATENCY: REVISITING A HISTORICAL TREATMENT OPTION FOR PORTAL HYPERTENSION
Author(s) -
Hugh McGregor,
Greg Woodhead,
Mikin Patel,
Charles Hennemeyer
Publication year - 2020
Publication title -
lymphology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.21
H-Index - 46
eISSN - 2522-7963
pISSN - 0024-7766
DOI - 10.2458/lymph.4658
Subject(s) - medicine , stent , surgery , thoracic duct , portal hypertension , radiology , thoracic outlet , venography , percutaneous , decompression , cirrhosis , thrombosis , lymphatic system , thoracic outlet syndrome , immunology
This report introduces the rationale for thoracic duct stent-graft decompression in cirrhotic patients with portal hypertension and provides a case example with 3-month stent-graft patency. Thoracic duct flow and pressure are elevated in cirrhosis. Historically, complications of portal hypertension have been successfully treated with external drainage of the thoracic duct or surgical lymphovenous bypass. A 45-year-old woman with cirrhosis, chronic portosplenomesenteric thrombosis, and acute variceal hemorrhage underwent percutaneous thoracic duct stent-graft placement across the lymphovenous junction. The hemorrhage subsequently resolved and follow up endoscopy demonstrated decom-pression of the bleeding varices. Venography 40 days later demonstrated a partially patent stent-graft with fibrin sheath formation distally. The stent-graft was extended distally to the right atrium and was fully patent on venography 3 months later. The patient had no further episodes of hemorrhage.