Treatment of idiopathic chylothorax in dogs and cats: A systematic review

Abstract

ObjectiveTo evaluate the evidence published on the treatment of idiopathic chylothorax (IC) in small animals.Study designSystematic literature review.Sample populationDogs and cats with IC.MethodsA literature search was performed in three bibliographic databases in July 2018 for publications on IC in dogs and cats. Articles meeting criteria for inclusion were evaluated for treatment, survival, outcome data, and level of evidence (LoE) with a modified Oxford Level of Evidence (mOLE) and GRADE (Grading of Recommendations, Assessment, Development and Evaluations) system.ResultsEleven of 313 identified articles met the inclusion criteria. Only one study was identified in dogs as having higher LoE by using the mOLE system, whereas no study was identified as such in either species with the GRADE system. Surgery was the primary treatment in all dogs and in 93% (68/73) of cats. Medical therapy was the primary treatment in 7% (5/73) of cats. The most common surgical treatment combined thoracic duct ligation (TDL) and subtotal pericardiectomy (SP; 40%; 34/84) in dogs and TDL in cats (51% [37/73]).ConclusionThe body of literature for IC treatment in small animals was limited to one higher LoE study in dogs and none in cats. No strong conclusion could be drawn regarding the effectiveness of any one surgical method in dogs or cats, and no evidence was found to support medical therapy as a primary treatment.Clinical significanceThe best available evidence regarding the treatment of IC is published in dogs and provides some support for surgical treatment with either TDL + cisterna chyli ablation or TDL + SP. Additional evidence is required to confirm this finding.

Publication Rate and Evidence-Based Evaluation of Abstracts Presented at the Annual Veterinary Orthopedic Society Conference

“…5,8 Currently, there are multiple grading schemes available with no clear consensus in veterinary medicine regarding the best method to critically evaluate clinical studies. 5,[10][11][12][13][14][15][16] Therefore, it is possible that use of an alternative system may have provided different results than those reported in this study. The Oxford Centre for Evidence-Based Medicine (OCEBM) attempts to provide an objective measure for evaluating LoE based on study design.…”

“…The Oxford Centre for Evidence-Based Medicine (OCEBM) attempts to provide an objective measure for evaluating LoE based on study design. 15,16 However, failure to report study design, disparity between the stated study design and what is described within the abstract and insufficient detail to determine study design all offer challenges when using this system with scientific abstracts. In addition, discrepancy in study design may exist between abstract and final publication.…”

Chylopericardium Effusion in a Lac Alaotra Bamboo Lemur (Hapalemur alaotrensis)

“…Some patients do not need surgical treatment, and they can be treated with conservative therapy and effective drainage, but a failure rate of 57-60% has been reported. In fact, the data presented by Reeves et al (2019) provide no strong evidence in the literature for the use of medical therapy as a primary treatment method for idiopathic chylopericardium in dogs and cats [11]. Thoracic duct ligation and a pericardial window are the most effective procedures to prevent recurrence [7,12].…”

“…In addition, it is difficult to draw strong conclusions regarding the effectiveness of any one surgical treatment for idiopathic chylopericardium rather than another in either dogs or cats. However, the best available evidence at this time is in dogs, and, although the evidence is limited, it appears to support surgery with either thoracic duct ligation and cisterna chyli ablation or thoracic duct ligation and subtotal pericardiectomy [11].…”

Granulomatöse Pleuritis und Chylothorax durch Kalzitinhalation bei einem Galgo Español

“…Im vorliegenden Fall blieben die Nebenwirkungen unverändert. Eine chirurgische Behandlung (Abbinden des Ductus thoracius, Perikardektomie, Ablation der Cisterna chyli) wie bei einem idiopathischem Chylothorax [1] [11][20] [44] wurde nicht in Erwägung gezogen, da sich der Auslöser damit nicht hätte beseitigen lassen. Zur weiteren Behandlung wäre ein Pleuroportsystem in Betracht gekommen, dessen Einsatz bei einigen Hunden und Katzen als Management chronisch rezidivierender Pleuraergüsse beschrieben wurde [10].…”