Fig. 8

Illustration of TDE using coils and sequential NBCA/lipiodol mixture embolization. A 22-gauge Chiba needle was punctured into the cisterna chyli (white arrowhead) under fluoroscopy (A). Then, remove the stylet and coaxially exchange a 0.018-inch guidewire into the thoracic duct (B). Coaxially advance a microcatheter into the thoracic duct and conduct an angiography to delineate the complete thoracic duct (white arrowheads) using the water-soluble iodinated contrast (C). Afterwards, advance the microcatheter into the distal part of the thoracic duct with reference to the angiographic image and release four coils (4 mm*14 cm, Nester® Embolization Coil, Cook Medical, Bloomington, USA) followed by glue injection (in this pig, 4 ml 1:2 NBCA/lipiodol mixture was used) with the simultaneous withdrawal of the microcatheter under fluoroscopy (D). After the accomplishment of embolization, perform the fluoroscopy (E) and CT scan (MIP image, F) to demonstrate the embolized thoracic duct presenting as a linear opacity. Images were from Pig No. 8. Abbreviations: TDE, thoracic duct embolization; NBCA, N-butyl-2-cyanoacrylate; CT, computed tomography; MIP, maximum intensity projection