Xu RB, Crouch G, Jurisevic C, Stuklis RG.
J Thorac Cardiovasc Surg 2013 Jun;145(6):e64-5. doi: 10.1016/j.jtcvs.2013.02.029.
A 71-year-old man presented with ongoing expectoration of milky, foul-tasting sputum, while denying any systemic symptoms. He first presented in 2007 with a type B dissection with an aneurysmal complex. He underwent distal aortic arch repair via a left anterolateral thoracotomy approach with femoral-femoral bypass via percutaneous cannulas. The distal aortic arch was transected and a 26-mm Dacron graft was sutured, with a distal anastomosis formed below the pulmonary hilum to the distal descending thoracic aorta.
Iatrogenic injury to the thoracic duct is not an uncommon consequence of thoracic cavity surgery. We present a case of such an injury after a distal aortic arch repair, with persistent chylothorax and chyloptysis as a consequence. Although the preference of the original treating surgeon was to attempt surgical correction via redo thoracotomy, in this case, right-assisted video-assisted thoracoscopy duct ligation was used as a successful conclusive treatment modality. Because video-assisted thoracic surgery has relatively low morbidity and cost, earlier use of this approach is supported by the literature.