# Indocyanine green-assisted chyle leak identification and ligation after left carotid-subclavian bypass: a case report

## TL;DR

A rare case of chyle leak after a carotid-subclavian bypass was successfully treated using indocyanine green fluorescence imaging to locate and ligate the leak.

## Contribution

Demonstrates the novel use of indocyanine green fluorescence imaging for diagnosing and surgically managing refractory cervical chyle leaks.

## Key findings

- Indocyanine green fluorescence imaging successfully localized the leaking lymphatic vessel.
- Surgical ligation guided by ICG imaging resolved the chyle leak with uneventful postoperative recovery.
- ICG-assisted imaging proved to be a safe and effective tool for managing refractory cervical chyle leaks.

## Abstract

Cervical chyle leak (CL) is a rare but potentially serious complication following carotid–subclavian bypass (CSB) during cervical debranching of supraaortic vessels. We report the case of a 62-year-old male who developed a postoperative CL after staged CSB and thoracic endovascular aortic repair. Initial conservative management with dietary modification and octreotide resulted in temporary improvement; however, recurrence occurred after reintroduction of dietary fats. Surgical re-exploration with intraoperative indocyanine green (ICG) fluorescence imaging enabled precise localization and successful ligation of the leaking lymphatic vessel. Postoperative recovery was uneventful, with complete resolution of the CL. This case highlights the value of ICG-assisted imaging as a safe and effective adjunct for the diagnosis and surgical management of refractory cervical CL, particularly in patients with prosthetic vascular grafts.