Thoracic Duct leak after Thoracoabdominal Aortic Aneurysm Repair.
60 year old gentleman underwent a open thoracoabdominal aortic aneurysm repair for a chronic aortic dissection under DHCA. Patient did well however on the third post-operative day his chest tube output increased and changed to milky white color. His diet was changed to a low-fat diet and somatostatin was started. When the output from the chest tube did not subside he was made NPO and TPN was started. After conservative management failed he underwent a thoracic duct ligation by Dr. Faiz Bhora, Chief of Thoracic Surgery at Mount Sinai-St. Luke's Medical Center using the da Vinci Xi system via a right chest approach. The thoracic duct leak was successfully controlled (see image above, clip applied on the thoracic duct).
How would you manage a thoracic duct leak after TAA repair?
- Conservative management only
- Conservative management for 7 days and then operate?
- Conservative management for 14 days and then operate?
- Lymphangiogram and coiling?
- Re-open left thoracoabdominal incision, locate the leak and ligate.
- Other
Clinical Professor
6 年Well done
Staff cardiac surgeon at BGUH
7 年Agree with Dr Levy , sounds a good plan!
Chief Medical Officer and Cardiothoracic Surgeon at Baptist Memorial Health Care
7 年Conservative therapy for 7 days and then either open surgery vs coiling (if expertise is present at center).