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Hawker W, Singh A. Advances in the Treatment of Chylothorax. Vet Clin North Am Small Anim Pract 2024; 54:707-720. [PMID: 38503596 DOI: 10.1016/j.cvsm.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Idiopathic chylothorax is a challenging clinical condition historically associated with poor resolution rates following surgical intervention. Recent advances in imaging and surgical techniques have revolutionized the treatment of this disease process. Computed tomographic lymphangiography has facilitated improved surgical planning and postoperative assessment, while intraoperative use of near-infrared fluorescence imaging aids in highly accurate intraoperative thoracic duct identification. Utilizing these advancements, minimally invasive surgical techniques have been successfully developed and have been associated with considerable improvements in surgical outcomes.
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Affiliation(s)
- William Hawker
- Department of Clinical Studies, The Ontario Veterinary College, University of Guelph, 26 College Avenue West, Guelph, N1G 2W1, Ontario, Canada.
| | - Ameet Singh
- Department of Clinical Studies, The Ontario Veterinary College, University of Guelph, 26 College Avenue West, Guelph, N1G 2W1, Ontario, Canada
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2
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Carvajal JL, Case JB, Vilaplana Grosso F, Huynh E, Verpaalen V, Fox-Alvarez A, Regier PJ. Anatomic and volumetric characterization of the cisterna chyli using CT lymphangiography and computer-assisted design software in dogs with idiopathic chylothorax. Vet Radiol Ultrasound 2020; 61:312-321. [PMID: 32125022 DOI: 10.1111/vru.12851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 11/29/2019] [Accepted: 01/06/2020] [Indexed: 01/23/2023] Open
Abstract
The objectives of this retrospective, observational study were to characterize the anatomical features of the cisterna chyli (CC) in a cohort of dogs diagnosed with idiopathic chylothorax that underwent CT lymphangiography (CTLa), and to evaluate the feasibility of computer-assisted design (CAD) software to quantify volumetric measurements of the CC. Twenty-three client-owned dogs with idiopathic chylothorax were included. Additionally, CTLa was performed in three canine cadavers to assess the ability of CAD software to accurately acquire volumetric measurements. Injection sites, attenuation values, anatomic location, dimensions, and aortic diameter to CC ratio (Ao:CC) were recorded. Video records of video-assisted thoracic surgery (VATS) thoracic duct ligation (TDL) were reviewed in eight out of 23 dogs to compare operative and CTLa findings. The CC was dorsal and right-sided in 18 out of 23 dogs, located between L1 and L4 in 21 dogs, and extended as far cranially as T11 in two dogs. The median measurements for length, height, and width were 150.0, 5.5, and 13.3 mm, respectively. Median total volume was 1.82 mL. Median volumes to the right and left of the aorta were 1.46 and 0.49 mL, respectively (P = .014). Median total CC volume to body weight ratio (CC:bw) was 0.07 mL/kg. The presence of an intrathoracic CC was observed intraoperatively in six out of eight cases that underwent VATS TDL. Findings supported the use of CTLa and CAD as feasible methods for characterizing the CC in dogs diagnosed with chylothorax. These methods may facilitate interventional planning involving the CC such as embolization.
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Affiliation(s)
- Jose L Carvajal
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - J Brad Case
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Federico Vilaplana Grosso
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Elizabeth Huynh
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Valentine Verpaalen
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Alexander Fox-Alvarez
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Penny J Regier
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
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3
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Kanai H, Furuya M, Hagiwara K, Nukaya A, Kondo M, Aso T, Fujii A, Sasai K. Efficacy of en bloc thoracic duct ligation in combination with pericardiectomy by video-assisted thoracoscopic surgery for canine idiopathic chylothorax. Vet Surg 2019; 49 Suppl 1:O102-O111. [PMID: 31880337 DOI: 10.1111/vsu.13370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/21/2019] [Accepted: 11/30/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the outcomes of pericardiectomy performed with conventional clipping thoracic duct ligation (C-TDL) to those with en bloc thoracic duct ligation (EB-TDL) using video-assisted thoracoscopic surgery (VATS) for canine idiopathic chylothorax. STUDY DESIGN Retrospective consecutive case series. ANIMALS Thirteen client-owned dogs with idiopathic chylothorax. METHODS Medical records of dogs treated with pericardiectomy in combination with TDL by VATS without intraoperative contrast were reviewed. Five and seven dogs underwent C-TDL and EB-TDL, respectively, and 11 dogs were evaluated by preoperative and 7- to 10-days-postoperative computed tomography-lymphography (CTLG). No clinical symptoms with absent or minimal pleural effusion was defined as clinical improvement. Long-term remission (LTR) was defined as rapid resolution of pleural effusion and no recurrence for more than 1 year. Anesthesia time, operation time, the duration of hospitalization, and time until pleural effusion resolution were compared. RESULTS Clinical improvement was achieved in 91.7% of the cases (C-TDL, 4/5; EB-TDL, 7/7), excluding one case of intraoperative death. The LTR rate was significantly higher with EB-TDL (6/7 [85.7%]) than with C-TDL (1/5 [20%]). Anesthesia time, operation time, and time until pleural effusion resolution were significantly better with EB-TDL than with C-TDL. The rates of thoracic ducts visualization by postoperative CTLG were 100% (5/5) with C-TDL and 42.9% (3/7) with EB-TDL. CONCLUSION En bloc TDL was an effective treatment for canine idiopathic chylothorax in this patient population. It compared favorably to C-TDL, although missed branches at the time of surgery may explain the difference between C-TDL and EB-TDL in this small population of cases. CLINICAL SIGNIFICANCE En bloc TDL by VATS was an effective minimally invasive treatment for canine idiopathic chylothorax. Computed tomography-lymphography can be used for surgical planning and postoperative evaluation.
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Affiliation(s)
- Hiroo Kanai
- Kanai Veterinary Surgery, Himeji, Hyogo, Japan.,Study group of Small Animal Minimally Invasive Treatment (SAMIT)
| | - Masaru Furuya
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Science, Osaka Prefecture University, Izumisano, Osaka, Japan
| | - Ken Hagiwara
- Study group of Small Animal Minimally Invasive Treatment (SAMIT).,Department of Digestive Surgery, Nihon University School of Medicine, Chiyoda, Tokyo, Japan
| | - Aya Nukaya
- Study group of Small Animal Minimally Invasive Treatment (SAMIT).,Aya Animal Hospital, Nara City, Nara, Japan
| | - Motoki Kondo
- Study group of Small Animal Minimally Invasive Treatment (SAMIT).,Apple Tree Animal Hospital, Anjo, Aichi
| | - Toshihide Aso
- Study group of Small Animal Minimally Invasive Treatment (SAMIT).,Animal Medical Center ALOHA, Fukuyama, Hiroshima
| | - Ayako Fujii
- Kanai Veterinary Surgery, Himeji, Hyogo, Japan
| | - Kazumi Sasai
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Science, Osaka Prefecture University, Izumisano, Osaka, Japan
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Barbur L, Millard HT, Baker S, Klocke E. Spontaneous Resolution of Postoperative Chylothorax Following Surgery for Persistent Right Aortic Arch in Two Dogs. J Am Anim Hosp Assoc 2014; 50:209-15. [PMID: 24659722 DOI: 10.5326/jaaha-ms-5994] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Two young dogs underwent surgical management of a persistent right aortic arch (PRAA) and developed chylothorax postoperatively. In both cases, the surgical procedure and anesthetic recovery were uncomplicated and routine. Following surgery, both patients appeared bright, alert, responsive, and previous signs of regurgitation had resolved. Dyspnea and tachypnea developed 1–2 days postoperatively in each patient, and chylous effusion was detected on thoracocentesis. For each case, a diagnosis of chylothorax was based on cytology and triglyceride concentrations of the aspirated pleural fluid. Similar protocols for monitoring were used in the treatment of each patient’s chylothorax. The duration and volume of chylous effusion production were closely monitored via routine thoracostomy tube aspiration. Both dogs rapidly progressed to recovery with no additional complications. With diligent monitoring, chylothorax secondary to surgical trauma can resolve in a rapid, uncomplicated manner.
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Affiliation(s)
- Laura Barbur
- Veterinary Teaching Hospital, Kansas State University, Manhattan, KS (L.B., E.K.); Purdue University Veterinary Teaching Hospital, West Lafayette, IN (H.M.); and Veterinary Teaching Hospital, Animal Emergency & Treatment Center, Grayslake, IL (S.B.)
| | - Heather Towle Millard
- Veterinary Teaching Hospital, Kansas State University, Manhattan, KS (L.B., E.K.); Purdue University Veterinary Teaching Hospital, West Lafayette, IN (H.M.); and Veterinary Teaching Hospital, Animal Emergency & Treatment Center, Grayslake, IL (S.B.)
| | - Steve Baker
- Veterinary Teaching Hospital, Kansas State University, Manhattan, KS (L.B., E.K.); Purdue University Veterinary Teaching Hospital, West Lafayette, IN (H.M.); and Veterinary Teaching Hospital, Animal Emergency & Treatment Center, Grayslake, IL (S.B.)
| | - Emily Klocke
- Veterinary Teaching Hospital, Kansas State University, Manhattan, KS (L.B., E.K.); Purdue University Veterinary Teaching Hospital, West Lafayette, IN (H.M.); and Veterinary Teaching Hospital, Animal Emergency & Treatment Center, Grayslake, IL (S.B.)
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Clendaniel DC, Weisse C, Culp WTN, Berent A, Solomon JA. Salvage cisterna chyli and thoracic duct glue embolization in 2 dogs with recurrent idiopathic chylothorax. J Vet Intern Med 2014; 28:672-7. [PMID: 24417399 PMCID: PMC4858019 DOI: 10.1111/jvim.12257] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 09/13/2013] [Accepted: 10/22/2013] [Indexed: 11/28/2022] Open
Affiliation(s)
- D C Clendaniel
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
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Pope JFA, Knowles T. The efficacy of n-butyl-cyanoacrylate tissue adhesive for closure of canine laparoscopic ovariectomy port site incisions. J Small Anim Pract 2013; 54:190-4. [DOI: 10.1111/jsap.12047] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J. F. A. Pope
- Highcroft Veterinary Group; Whitchurch Bristol BS14 9BE
| | - T. Knowles
- Highcroft Veterinary Group; Whitchurch Bristol BS14 9BE
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Leasure CS, Ellison GW, Roberts JF, Coomer AR, Choate CJ. Occlusion of the thoracic duct using ultrasonically activated shears in six dogs. Vet Surg 2012; 40:802-10. [PMID: 22380666 DOI: 10.1111/j.1532-950x.2011.00903.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the feasibility of sealing the thoracic duct (TD) in dogs using ultrasonically activated shears via thoracoscopy. STUDY DESIGN In vivo experimental study. ANIMALS Mature dogs (n = 6). METHODS Dogs were anesthetized without pulmonary exclusion and positioned in left lateral recumbency. Lymphangiography was performed to identify TD anatomy. Methylene blue was injected into the lymphatic catheter to identify the TD and its branches. Under thoracoscopic guidance (right dorsal 8-10th intercostal spaces), the TD was sealed with an ultrasonic device and lymphangiography was repeated. If the flow of contrast continued beyond the occlusion site, additional attempts to seal the duct were made. Dogs were euthanatized, the TD was excised and fixed in formalin for histopathology. RESULTS Thoracoscopic identification of the TD was possible in 5 dogs. Three dogs required conversion to a thoracoscopic-assisted approach and 3 dogs required resealing of the TD closer to the diaphragm. Thoracic duct occlusion (TDO) was ultimately achieved in all 6 dogs based on follow-up lymphangiography. TDO by tissue coagulation was confirmed by histopathology. CONCLUSIONS Thoracoscopic identification and occlusion of the TD using ultrasonically activated shears with bilateral lung ventilation is technically feasible in normal dogs and provides a less invasive alternative to open thoracotomy procedures.
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Affiliation(s)
- Christopher S Leasure
- Department of Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, FL 32610, USA
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8
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Singh A, Brisson BA, O'Sullivan ML, Solomon JA, Malek S, Nykamp S, Thomason JJ. Feasibility of percutaneous catheterization and embolization of the thoracic duct in dogs. Am J Vet Res 2011; 72:1527-34. [DOI: 10.2460/ajvr.72.11.1527] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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9
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Sakals S, Schmiedt CW, Radlinsky MG. Comparison and Description of Transdiaphragmatic and Abdominal Minimally Invasive Cisterna Chyli Ablation in Dogs. Vet Surg 2011; 40:795-801. [DOI: 10.1111/j.1532-950x.2011.00889.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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McAnulty JF. Prospective Comparison of Cisterna Chyli Ablation to Pericardectomy for Treatment of Spontaneously Occurring Idiopathic Chylothorax in the Dog. Vet Surg 2011; 40:926-34. [DOI: 10.1111/j.1532-950x.2011.00902.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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da Silva CA, Monnet E. Long-term outcome of dogs treated surgically for idiopathic chylothorax: 11 cases (1995–2009). J Am Vet Med Assoc 2011; 239:107-13. [DOI: 10.2460/javma.239.1.107] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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MILLWARD IANR, KIRBERGER ROBERTM, THOMPSON PETERN. COMPARATIVE POPLITEAL AND MESENTERIC COMPUTED TOMOGRAPHY LYMPHANGIOGRAPHY OF THE CANINE THORACIC DUCT. Vet Radiol Ultrasound 2011; 52:295-301. [DOI: 10.1111/j.1740-8261.2010.01790.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Stewart K, Padgett S. Chylothorax Treated Via Thoracic Duct Ligation and Omentalization. J Am Anim Hosp Assoc 2010; 46:312-7. [DOI: 10.5326/0460312] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Chylothorax is an uncommon, potentially life-threatening disease of dogs and cats. Medical records of 12 animals (five dogs and seven cats) undergoing surgical management of chylothorax from 2001 to 2005 were reviewed. All animals received thoracic duct ligation and thoracic omentalization. In some cases, a combination of subtotal pericardectomy and/or pleural stripping was also employed. All animals survived surgery, and none was lost to follow-up. Median survival time for cats was 209 days (range 2 to 1328 days), and for dogs it was 211 days (range 7 to 991 days). Although postoperative mortality was higher than in other recent studies, no complications could be directly attributed to thoracic omentalization. A controlled, prospective study is needed to compare outcomes of this management method to those of other methods.
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Affiliation(s)
- Kayla Stewart
- Department of Surgery (Stewart), Chesapeake Veterinary Surgical Specialists, 808 Bestgate Road, Annapolis, Maryland 21401
- Metropolitan Veterinary Referral Group (Padgett), 1053 South Cleveland-Massillon Road, Akron, Ohio 44321
- From the
| | - Sheldon Padgett
- Department of Surgery (Stewart), Chesapeake Veterinary Surgical Specialists, 808 Bestgate Road, Annapolis, Maryland 21401
- Metropolitan Veterinary Referral Group (Padgett), 1053 South Cleveland-Massillon Road, Akron, Ohio 44321
- From the
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14
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ALLMAN DAVIDA, RADLINSKY MARYANNG, RALPH ALANG, RAWLINGS CLARENCEA. Thoracoscopic Thoracic Duct Ligation and Thoracoscopic Pericardectomy for Treatment of Chylothorax in Dogs. Vet Surg 2010; 39:21-7. [DOI: 10.1111/j.1532-950x.2009.00623.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Weisse CW, Berent AC, Todd KL, Solomon JA. Potential applications of interventional radiology in veterinary medicine. J Am Vet Med Assoc 2008; 233:1564-74. [PMID: 19014289 DOI: 10.2460/javma.233.10.1564] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Chick W Weisse
- Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Hayashi K, Sicard G, Gellasch K, Frank JD, Hardie RJ, McAnulty JF. Cisterna Chyli Ablation with Thoracic Duct Ligation for Chylothorax: Results in Eight Dogs. Vet Surg 2005; 34:519-23. [PMID: 16266346 DOI: 10.1111/j.1532-950x.2005.00078.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To report use of combined cisterna chyli ablation (CCA) and thoracic duct ligation (TDL) for treatment of spontaneously occurring chylothorax in dogs. STUDY DESIGN Retrospective study. ANIMALS Eight dogs with chylothorax. METHODS TDL was performed through a right caudal intercostal thoracotomy and CCA through a left flank paracostal approach or ventral median celiotomy. Long-term outcome (range, 2-48 months; median, 11.5 months) was evaluated by telephone communication with owners. RESULTS Seven dogs were free of clinical signs related to chylothorax at last follow-up (range, 4-48 months; median, 15.5 months). One dog was euthanatized 2 months after surgery because of lack of improvement. No major complications occurred from CCA. CONCLUSION CCA and TDL resolved chylothorax in most dogs (88%). CLINICAL RELEVANCE CCA combined with TDL may improve the outcome of chylothorax in dogs.
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Affiliation(s)
- Kei Hayashi
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706, USA
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Esterline ML, Radlinsky MG, Biller DS, Mason DE, Roush JK, Cash WC. COMPARISON OF RADIOGRAPHIC AND COMPUTED TOMOGRAPHY LYMPHANGIOGRAPHY FOR IDENTIFICATION OF THE CANINE THORACIC DUCT. Vet Radiol Ultrasound 2005; 46:391-5. [PMID: 16250396 DOI: 10.1111/j.1740-8261.2005.00071.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Standard radiographic lymphangiograms and computed tomography (CT) lymphangiograms were performed on 10 female dogs without intrathoracic disease. Positive contrast lymphagiography was performed by injection into a catheterized mesenteric lymphatic vessel, and lateral thoracic radiographs, ventrodorsal thoracic radiographs, and thoracic CTs were obtained. The number of visible ducts was recorded for each image at the midbody of the ninth thoracic vertebra (T9) through the first lumbar vertebra (L1). Data were combined for all dogs at each data acquisition point. Data were analyzed by comparing data from all three images independently, and then by combining data for the radiographs and comparing the study with the highest number of visible duct branches to the CT. Significant differences in numbers of branches were found at T11 and L1. This study suggests that CT may be able to quantify branches of the thoracic duct more accurately than standard radiographic lymphangiography.
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Affiliation(s)
- Meredith L Esterline
- Department of Clinical Sciences, College of Veterinary Medicine, Veterinary Medical Teaching Hospital, Kansas State University, Manhattan, KS 66506, USA.
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Sicard GK, Waller KR, McAnulty JF. The Effect of Cisterna Chyli Ablation Combined with Thoracic Duct Ligation on Abdominal Lymphatic Drainage. Vet Surg 2005; 34:64-70. [PMID: 15720599 DOI: 10.1111/j.1532-950x.2005.00012.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the effect of cisterna chyli ablation (CCA) and thoracic duct ligation (TDL) on abdominal lymphatic drainage in normal dogs. STUDY DESIGN Experimental study. ANIMALS Nine female beagle dogs. METHODS TDL was performed in 3 dogs and was combined with CCA (CCA-TDL) and local omentalization in 6 dogs. Contrast lymphangiography was attempted in all dogs immediately before and after TDL. Dogs were reanesthetized at 31-37 days for lymphatic studies by new methylene blue (NMB) injection into a mesenteric lymph node and by contrast lymphangiography. RESULTS In 6 CCA-TDL dogs, 2 had direct shunting of contrast from the lymphatic system into major abdominal veins, 3 had contrast material that dissipated into abdominal vessels within the mesenteric root, and 1 had shunting into the azygous vein. NMB was not observed within the omental pedicle after CCA-TDL. Chylous drainage was by the azygous vein in all 3 TDL dogs. CONCLUSIONS CCA-TDL disrupted chylous drainage to the thoracic duct and resulted in direct intraabdominal lymphaticovenous anastomoses identified by shunting of lymphatic flow directly into the abdominal vasculature in 5 of 6 CCA-TDL dogs. Omentalization of the cisternal ablation site was not beneficial in augmenting extrathoracic lymphatic drainage and is not recommended with CCA-TDL. CLINICAL RELEVANCE CCA-TDL represents a novel approach to surgical redirection of chylous drainage to the venous circulation outside of the thorax and may be useful in the treatment of spontaneous chylothorax in the dog.
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Affiliation(s)
- Gretchen K Sicard
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706, USA
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19
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Enwiller TM, Radlinsky MG, Mason DE, Roush JK. Popliteal and mesenteric lymph node injection with methylene blue for coloration of the thoracic duct in dogs. Vet Surg 2003; 32:359-64. [PMID: 12865998 DOI: 10.1053/jvet.2003.50044] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To describe and compare the time of onset and intensity of thoracic duct coloration after injection of methylene blue into a mesenteric or popliteal lymph node. STUDY DESIGN Experimental study. ANIMALS Twenty adult dogs. METHODS A right tenth intercostal thoracotomy, a right paracostal laparotomy, and an approach to the right popliteal lymph node were performed on each dog. Methylene blue (0.5 mg/kg of a 1% solution, maximum 10 mg) was injected into either a mesenteric (group M, 10 dogs) or popliteal (group P, 10 dogs) lymph node. Thoracic duct color was graded (0 to 3) every 5 minutes for 60 minutes. Statistical analysis was performed on mean thoracic duct color grade data, on number of successful outcomes between groups M and P, and between weight groups. RESULTS Coloration of the thoracic duct occurred in all group M dogs and 6 group P dogs. Coloration was first recorded 0 to 10 minutes after injection in all dogs and persisted for 60 minutes in 15 dogs. Mean thoracic duct color grade was significantly increased postinjection compared with preinjection at all times in group M. More successful outcomes occurred in group M (P =.03). CONCLUSIONS Methylene blue injected into mesenteric or popliteal lymph nodes was successful in coloring the thoracic duct, but both mean grade and number of successful outcomes were significantly higher after mesenteric injection. CLINICAL RELEVANCE Thoracic duct coloration after lymph node injection occurred within 10 minutes and persisted for 60 minutes. This information is useful in planning thoracic duct ligation in cases of chylothorax when observation of the duct is desired. Injection of both lymph node sites was successful, but mesenteric node injection was a more reliable technique.
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Affiliation(s)
- Tara M Enwiller
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS, USA
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20
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Weisse C, Clifford CA, Holt D, Solomon JA. Percutaneous arterial embolization and chemoembolization for treatment of benign and malignant tumors in three dogs and a goat. J Am Vet Med Assoc 2002; 221:1430-6, 1419. [PMID: 12458612 DOI: 10.2460/javma.2002.221.1430] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The term bland arterial embolization refers to catheter-directed delivery of particulate material for the purpose of embolizing selected arteries. This technique is used in humans to treat a number of conditions, including arteriovenous malformations, uterine fibroids, and epistaxis. The term chemoembolization refers to selective intra-arterial delivery of chemotherapeutic agents in conjunction with particulate material for the purpose of embolizing arteries supplying blood to a tumor. Compared with traditional modes of drug delivery, chemoembolization increases local concentration and dwell time of the chemotherapeutic agent, augments tumor ischemia, and minimizes systemic toxic effects. In humans, the technique has shown encouraging results in the treatment of a variety of nonresectable tumors. The present report describes techniques for percutaneous bland arterial embolization and chemoembolization in dogs and goats and results of these techniques in 3 dogs and a goat. Bland arterial embolization was performed in 2 dogs and the goat. The goals of treatment included pain palliation, reduction of tumor growth, and control of hemorrhage, and each animal was considered to have benefited from the procedure on the basis of the preprocedural goals. Chemoembolization was performed in 1 dog for treatment of a nonresectable hepatocellular carcinoma. Unfortunately, this dog did not live long enough to identify any response to treatment. Results for animals studied illustrate the feasibility of bland arterial embolization and chemoembolization in veterinary patients and suggest that embolization may provide an alternative method of treatment for animals with inoperable lesions.
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Affiliation(s)
- Chick Weisse
- Section of Small Animal Surgery, Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104-6010, USA
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Cope C, Kaiser LR. Management of unremitting chylothorax by percutaneous embolization and blockage of retroperitoneal lymphatic vessels in 42 patients. J Vasc Interv Radiol 2002; 13:1139-48. [PMID: 12427814 DOI: 10.1016/s1051-0443(07)61956-3] [Citation(s) in RCA: 156] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To demonstrate the applicability, technique, and efficacy of percutaneous transabdominal catheter embolization or needle disruption of retroperitoneal lymphatic vessels in the treatment of high-output or unremitting chylothorax. MATERIALS AND METHODS Forty-two patients (21 men, 21 women; mean age, 56 y; range, 19-80 y) who had chylothorax with various etiologies were referred from the thoracic surgery department for treatment as soon as chylothorax was documented. The thoracic duct was punctured and catheterized via a peritoneal cannula to facilitate embolization with use of microcoils, particles, or glue; if there were no lymph trunks that could be catheterized, attempts were made to disrupt lymph collaterals with use of needles. RESULTS The thoracic duct was catheterized in 29 patients and embolized in 26 patients. In patients with lymph trunks that could be catheterized, treatment resulted in cure within 7 days in 16 patients and partial response with cure within 3 weeks in six patients. In the patients with lymph trunks that could not be catheterized (n = 16), disruption with use of needles resulted in cure in five patients and partial response in two patients. Cure and partial response rates after thoracic duct embolization and needle disruption were 73.8%, with no morbidity. Surgical thoracic duct ligation was performed in seven patients. The nonprocedural mortality rate was 19%. Follow-up was 3 months or longer. CONCLUSIONS Effective percutaneous treatment of high-output or medically uncontrollable chylothorax was performed promptly and safely in more than 70% of referred cases. This procedure should be attempted, especially if patients are very ill, before riskier surgical thoracic duct ligation is considered.
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Affiliation(s)
- Constantin Cope
- Section of Interventional Radiology and Thoracic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, Pennsylvania 19104, USA.
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Lafond E, Weirich WE, Salisbury SK. Omentalization of the thorax for treatment of idiopathic chylothorax with constrictive pleuritis in a cat. J Am Anim Hosp Assoc 2002; 38:74-8. [PMID: 11804320 DOI: 10.5326/0380074] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 6-year-old, spayed female Himalayan cat with idiopathic chylothorax, which failed to respond to medical management, was successfully treated by advancement of the omentum into the thorax. Exploratory thoracotomy revealed severe, constrictive pleuritis as a sequela to chylothorax. Because of the poor prognosis for recovery from chylothorax in cats with thoracic duct ligation alone, and the lack of success in performing thoracic duct ligation in this cat, the omentum was advanced into the thorax through a hole created in the diaphragm and sutured within the thoracic cavity. The cat recovered from surgery and is clinically normal 13 months postoperatively. Omental advancement may be an effective surgical management technique for this challenging disease in cats.
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Affiliation(s)
- Elizabeth Lafond
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, West Lafayette, Indiana 47907, USA
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Abstract
OBJECTIVES To describe a novel technique for the surgical treatment of idiopathic chylothorax in a dog. ANIMALS A 6-year-old, male Rhodesian Ridgeback, which presented with a history of reduced exercise tolerance and dyspnea. METHODS Idiopathic chylothorax was diagnosed. Intermittent pleural drainage failed to resolve the problem. During surgery, extensive pleural fibrosis made it impossible to identify the thoracic duct. A dorsal omental pedicle was advanced through an incision in the diaphragm and into the cranial thoracic cavity to act as a physiological drain. RESULTS The dog recovered well and has remained free from clinical signs of recurrence of the effusion (16 months at the time of writing). CONCLUSIONS The disease-free interval achieved in this dog indicates that this novel technique is worthy of further consideration in the management of idiopathic chylothorax.
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Affiliation(s)
- J M Williams
- Small Animal Teaching Hospital, The University of Liverpool, UK
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Cope C. Percutaneous transabdominal embolization of thoracic duct lacerations in animals. J Vasc Interv Radiol 1996; 7:725-31. [PMID: 8897342 DOI: 10.1016/s1051-0443(96)70840-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To develop percutaneous techniques for lacerating the thoracic duct (TD) and to assess the efficacy of percutaneous TD embolization. MATERIALS AND METHODS The TD was catheterized by means of antegrade or antegrade-retrograde techniques after the lymphographically opacified cisterna chyli (CC) was punctured in five swine and one dog. The TD was lacerated by fluid overdistention (n = 1), perforated with stiff guide wires (n = 3) or a 5-F styletted catheter (n = 1), or macerated by rotational guide-wire trauma (n = 1). The TD was percutaneously embolized in five animals with steel (n = 2) and platinum (n = 3) coils. The CC containing a metal target was recatheterized 2-7 days after embolization. RESULTS All types of TD trauma led to mediastinal extravasation. The one chylothorax was induced by the 5-F styletted catheter. The TD of four animals was promptly thrombosed with coils. In the fifth animal, the TD failed to thrombose 3 days after embolization, probably because of the use of an undersized platinum are coil. There were no immediate or delayed complications. Necropsy in five animals was unremarkable. The sixth animal was alive and well at 4 months. CONCLUSIONS Percutaneous transcatheter TD trauma led to mediastinal extravasation in all six animals, but chylothorax occurred in only one animal. TD coil embolization led to duct thrombosis in four of five animals with no early or late complications. The technique has potential clinical applications for localization and selective embolization of TD leaks in debilitated patients.
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Affiliation(s)
- C Cope
- Dotter Institute for Interventional Therapy, Oregon Health Sciences University, Portland, USA
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