Endovascular treatment of chylothorax associated with thrombosis of superior vena cava tributaries

Chylothorax is a rare life-threatening complication in pediatric surgery. One of the causes is thrombosis of superior vena cava tributaries at the entry of the thoracic duct. Conservative therapy for chylothorax is often ineffective, and current endovascular treatments in children are still poorly studied. Two children with massive chylothorax caused by occlusion of superior vena cava tributaries were examined. Conservative treatment and pleural drainage were ineffective. All patients underwent direct antegrade phlebography of the upper extremities and chest, followed by endovascular mechanical recanalization and balloon angioplasty of superior vena cava tributaries. One child received a peripherally implanted central venous catheter through the recanalized area. Postoperatively, pleural output was controlled. Both patients showed positive dynamics. Lymph drainage through the drains ceased on days 8 and 22 postoperatively. Endovascular techniques, combined with conservative therapy, demonstrate minimal invasiveness, efficacy, and safety in the treatment of chylothorax associated with thrombosis of superior vena cava tributaries.