Lymphaticovenous bypass of the thoracic duct for the treatment of chylous leak in central conducting lymphatic anomalies

Taghinia, Amir H.; Upton, Joseph; Trenor, Cameron C.; Alomari, Ahmad I.; Lillis, Anna P.; Shaikh, Raja; Burrows, Patricia E.; Fishman, Steven J.

doi:10.1016/j.jpedsurg.2018.08.056

Cited by 31 publications

(18 citation statements)

References 26 publications

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“…The latter is a rare disease that was not identified by our systematic research because of variable clinical manifestations, such as chylous ascites, protein-losing enteropathy, chylous pericardial effusion, vaginal chylorrhea, and so on. Taghinia et al 32 conducted a retrospective study, with 14 patients with central conducting lymphatic anomalies receiving lymphovenous anastomosis of the TD and a vein that led to complete remission of symptoms in 5 patients. Given that 50% of patients did not have any improvements, the authors supposed that the abnormalities of the lymphatic system are not only limited to the TD terminus and might be further associated by insufficient peristalsis of the lymphatic system.…”

Section: Discussionmentioning

confidence: 99%

Lymphovenous Anastomosis for the Treatment of Thoracic Duct Lesion

et al. 2019

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BACKGROUND Chylous leak is an uncommon complication after head and neck surgery and typically results from a lesion of the thoracic duct (TD). Beside conservative treatment, different minimally invasive and surgical procedures exist, of which almost all lead to a total closure of the TD. METHODS We report on a rare case of microsurgical lymphovenous anastomosis to treat a TD lesion. An additional systematic review on surgical procedures to treat TD lesions with special attention to lymphovenous anastomoses was performed according to the PRISMA guidelines. RESULTS A 52-year-old patient with a chylous fistula after modified radical neck dissection was successfully treated by a lymphovenous anastomosis of the TD and external jugular vein with additional coverage by sternocleidomastoid muscle flap. The patient showed a complete resolution of chylous leak with an uneventful postoperative course.The systematic search of literature yielded 684 articles with 4 case reports on lymphovenous anastomosis in chylous leak with a high success rate. Other surgical techniques include transcervical, thoracoscopic, or video-assisted thoracoscopic TD ligation, either alone or combined with a local muscle flap. CONCLUSIONS Lymphovenous anastomosis of the TD is a feasible and safe technique allowing for treatment of cervical TD lesions, especially if minimally invasive procedures fail. Compared with other techniques, lymphatic circulation can successfully be maintained.

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Section: Discussionmentioning

confidence: 99%

Lymphovenous Anastomosis for the Treatment of Thoracic Duct Lesion

et al. 2019

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“…Although limited to 2 cases, the use of LVA to manage recalcitrant chylothoraces warrants consideration as a surgical treatment option for this life-threatening condition. Taghinia et al [16] reported the results of LVA of the terminal thoracic duct in 14 patients with chylous leakage owing to central conducting lymphatic anomalies. They concluded that the bypass operation offered a chance of improvement or cure with relatively minimal risk for patients with refractory chyle leak secondary to central conducting lymphatic anomalies.…”

Section: Discussionmentioning

confidence: 99%

Lymphovenous anastomosis for the treatment of persistent congenital chylothorax in a low-birth-weight infant

Hayashida

Yamakawa²,

Shirakami³

2019

Medicine

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Rationale:Chylothorax remains a poorly understood phenomenon, and no optimal treatment or guidelines have been established. This is the first report of treating congenital chylothorax and lymphedema in a low-birth-weight infant by lymphovenous anastomosis (LVA).Patient concerns:We report a case of successful LVA for persistent congenital chylothorax and lymphedema resistant to other conservative therapies.Diagnosis:The diagnosis of chylothorax was confirmed by the predominance of lymphocytes in the pleural fluid draining from the chest tube. In addition, the infant developed oliguria and generalized lymphedema.Interventions:LVA under local anesthesia combined with light sedation was performed at his medial thighs and left upper arm.Outcomes:Although his subcutaneous edema markedly improved, the decrease in chest tube drainage was gradual. No additional treatment was required.Lessons:LVA is of considerable value as a surgical treatment option in the setting of persistent congenital chylothorax and lymphedema, because LVA is a less invasive procedure.

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“…Lymphaticovenous anastomosis has been used in human surgical practice since the 1960s for the treatment of lymphatic anomalies and lymphedema, a common sequela of vascular disruption from soft tissue infections, bone fractures, or oncologic surgery. [8][9][10] While these procedures generally involve the use of the distal limb lymphatics, anastomosis of the TD to various central veins has also been shown to be an effective treatment option for a range of thoracic conditions. Several recent case studies have documented either end-to-end or end-to-side anastomosis of the TD with the azygos, 11 external jugular, 12 or other local vein, 10 with long-term patency and no change in lipid metabolism, providing evidence that direct anastomosis of the TD to the central venous circulation is effective with minimal side effects.…”

Section: Introductionmentioning

confidence: 99%

“…[8][9][10] While these procedures generally involve the use of the distal limb lymphatics, anastomosis of the TD to various central veins has also been shown to be an effective treatment option for a range of thoracic conditions. Several recent case studies have documented either end-to-end or end-to-side anastomosis of the TD with the azygos, 11 external jugular, 12 or other local vein, 10 with long-term patency and no change in lipid metabolism, providing evidence that direct anastomosis of the TD to the central venous circulation is effective with minimal side effects. Most of these lymphaticovenous anastomoses are currently performed by using hand-suturing techniques, 8,9,13 despite microvascular anastomotic couplers (MAC) being wellestablished for use with end-to-end or end-to-side anastomoses.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Lymphaticovenous anastomosis of the caudal thoracic duct to an intercostal vein: A canine cadaver study

2020

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Objective: To describe a technique for anastomosis of the thoracic duct (TD) to the 11th or 12th intercostal vein (ICV) using a microvascular anastomotic coupler (MAC) in the dog. Study design: Cadaveric study. Animals: Eight beagles. Methods: A right paracostal laparotomy and 10th intercostal thoracotomy were performed in each dog. Mesenteric contrast lymphography was used to identify the TD and its branches on fluoroscopy. The TD and adjacent 11th or 12th ICV were isolated, double ligated, and divided using a surgical microscope. The caudal TD and proximal ICV were anastomosed in an end-to-end fashion using a 1.5 mm or 2 mm MAC. Mesenteric lymphography was repeated to document patency of the anastomosis. Results: The TD was identified via lymphography in all dogs; five dogs had a single duct, and three dogs had additional branches. The anastomosis was successful in all eight dogs, and flow into the azygos vein without leakage was confirmed via lymphography. Conclusion: End-to-end anastomosis of the TD to an ICV using a MAC was technically feasible in the canine cadaver. Clinical significance: Lymphaticovenous anastomosis combined with TD ligation may have application as a treatment for idiopathic chylothorax. By maintaining the flow of chyle from the abdominal lymphatics to the systemic circulation, this procedure may reduce the stimulus for collateral circulation and persistent flow to the cranial mediastinal lymphatics.

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Lymphaticovenous bypass of the thoracic duct for the treatment of chylous leak in central conducting lymphatic anomalies

Cited by 31 publications

References 26 publications

Lymphovenous Anastomosis for the Treatment of Thoracic Duct Lesion

Lymphovenous Anastomosis for the Treatment of Thoracic Duct Lesion

Lymphovenous anastomosis for the treatment of persistent congenital chylothorax in a low-birth-weight infant

Lymphaticovenous anastomosis of the caudal thoracic duct to an intercostal vein: A canine cadaver study

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