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The Effect of Cisterna Chyli Ablation Combined with Thoracic Duct Ligation on Abdominal Lymphatic Drainage

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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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Keywords: chylothorax; cisterna chyli; dog; thoracic duct

Document Type: Research Article

Affiliations: From the Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI

Publication date: January 1, 2005

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