Combined antegrade and retrograde approach for embolization of abdominal chyle leak

Chyle leaks are an uncommon but often morbid complication of surgical resections in the retroperitoneal space. They can lead to multiple/prolonged hospitalizations and significantly diminish patient quality of life. Here we present a case of recalcitrant chylous ascites following resection of a renal mass. Lymphatic embolization was attempted but unsuccessful on two occasions (antegrade followed by retrograde approach) at outside hospitals. We used a combined antegrade and retrograde approach to overcome his challenging anatomy and treat the chyle leak definitively. This case highlights the usefulness and reliability of this technique for achieving bidirectional control of the lymphatic system.