Ultrasound-Guided Anterograde Cervical Thoracic Duct Puncture Facilitating Retrograde Cannulation: An Access Route for Thoracic Duct Endoluminal Interventions.

The authors describe an ultrasound (US)-guided anterograde puncture technique for cervical thoracic duct (TD) access to facilitate retrograde endoluminal intervention. Between January 2020 and July 2025, 5 patients with chylothorax underwent this procedure. Under US visualization, the cervical TD or its ampulla was punctured antegradely. A micro-guide wire was advanced and externalized via a femoral venous sheath to establish a through-and-through guide wire pathway. This through-and-through micro-guide wire allowed for the subsequent retrograde advancement of a guiding catheter and microcatheter into the thoracic segment of the TD. The technical success rate was 100% for both puncture and retrograde cannulation. The mean procedural times for TD access and retrograde cannulation were 9.30 minutes (SD ± 4.27) and 28.00 minutes (SD ± 6.67), respectively. No complications, such as TD injury or cervical chylous leakage, were encountered. This technique provides a safe, feasible, and effective alternative access route for TD interventions when standard approaches are challenging.