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American Journal of Veterinary Research Nov 2011To develop and determine the feasibility of a novel minimally invasive technique for percutaneous catheterization and embolization of the thoracic duct (PCETD) in dogs...
OBJECTIVE
To develop and determine the feasibility of a novel minimally invasive technique for percutaneous catheterization and embolization of the thoracic duct (PCETD) in dogs and to determine thoricic duct TD pressure at rest and during short-term balloon occlusion of the cranial vena cava (CrVC).
ANIMALS
Fifteen 7- to 11-month-old healthy mixed-breed dogs.
PROCEDURES
Efferent intestinal lymphangiography was performed, and the cisterna chyli was punctured with a trochar needle percutaneously under fluoroscopic guidance. When access was successful, a guide wire was directed into the TD through the needle and a vascular access sheath was advanced over the guide wire. Thoracic duct pressure was measured at rest and during acute balloon occlusion of the CrVC. The TD was then embolized cranial to the diaphragm with a combination of microcoils and cyanoacrylate or ethylene vinyl alcohol.
RESULTS
Successful puncture of the cisterna chyli with advancement of a wire into the TD was possible in 9 of 15 dogs, but successful catheterization was possible in only 5 of 9 dogs. Acute balloon occlusion of the CrVC led to a substantial TD pressure increase in 4 of 4 dogs, and embolization of the TD was successful in 4 of 4 dogs.
CONCLUSIONS AND CLINICAL RELEVANCE
PCETD can successfully be performed in healthy dogs; however, this minimally invasive technique cannot currently be recommended for routine treatment of chylothorax, in part because of the technically demanding nature of the procedure. An increase in jugular venous pressure led to an increase in TD pressure, potentially predisposing some dogs to developing chylothorax.
Topics: Animals; Balloon Occlusion; Catheterization; Chylothorax; Dog Diseases; Dogs; Embolization, Therapeutic; Female; Lymphography; Male; Thoracic Duct
PubMed: 22023132
DOI: 10.2460/ajvr.72.11.1527 -
Biomedical Research (Tokyo, Japan) 2017Little information has been available regarding microanatomy of human thoracic duct in spite of the importance for an understanding of pathophysiology in clinical...
Little information has been available regarding microanatomy of human thoracic duct in spite of the importance for an understanding of pathophysiology in clinical medicine. The present study demonstrated a fine structure of human thoracic duct system by light and scanning electron microscopy. A number of longitudinal or spiral ridges and grooves were formed on luminal surfaces of the lymphangia and lymph sac, it likely facilitating fluent lymph flow. The endothelial cells displayed various cell shapes in compliance with their distributed regions. The lymph sac joining large vein composed a peculiar multiple valve structure presumably ensuring lymph storage and prevention of lymph backflow. The longitudinal muscle sheet in the tunica intima and circular muscle bundles in the tunica media constructed an integrated power unit probably eliciting spontaneous lymph propulsion. Furthermore, the thoracic duct was richly supplied with blood vessels not only in the tunica externa, but also just beneath the endothelium. The present findings provide a morphological basis for investigation of human thoracic duct in basic and clinical medicine.
Topics: Aged; Aged, 80 and over; Endothelium, Lymphatic; Female; Humans; Male; Microscopy, Electron, Scanning; Myocytes, Smooth Muscle; Thoracic Duct; Tunica Media
PubMed: 28637955
DOI: 10.2220/biomedres.38.197 -
Surgical Endoscopy Jul 2022Chyle leaks following oesophagectomy are a frustrating complication of surgery with considerable morbidity. The use of near infra-red (NIR) fluorescence in surgery is an... (Clinical Trial)
Clinical Trial
BACKGROUND
Chyle leaks following oesophagectomy are a frustrating complication of surgery with considerable morbidity. The use of near infra-red (NIR) fluorescence in surgery is an emerging technology and the use of fluorescence to identify the thoracic duct has been demonstrated in animal work and early human case reports. This study evaluated the use mesenteric and enteral administration of indocyanine green (ICG) in humans to identify the thoracic duct during oesophagectomy.
METHODS
Patients undergoing oesophagectomy were recruited to the study. Administration of ICG via an enteral route or mesenteric injection was evaluated. Fluorescence was assessed using a NIR fluorescence enabled laparoscope system with a visual scoring system and signal to background ratios. Visualisation of the thoracic duct under white light and NIR fluorescence was compared as well as any identification of active chyle leak. Patients were followed up post-operatively for adverse events and chyle leak.
RESULTS
20 patients received ICG and were included in the study. The enteral route failed to fluoresce the thoracic duct. Mesenteric injection (17 patients) identified the thoracic duct under fluorescence prior to white light in 70% of patients with a mean signal to background ratio of 5.35. In 6 participants, a possible active chyle leak was identified under fluorescence with 4 showing active chyle leak from what was identified as the thoracic duct.
CONCLUSION
This study demonstrates that ICG administration via mesenteric injection can highlight the thoracic duct during oesophagectomy and may be a potential technology to reduce chyle leak following surgery.
CLINICAL TRIAL REGISTRATION
Clinical trials.gov (NCT03292757).
Topics: Chyle; Esophagectomy; Fluorescence; Humans; Indocyanine Green; Thoracic Duct
PubMed: 34905086
DOI: 10.1007/s00464-021-08912-1 -
The Journal of Thoracic and... Mar 2010To demonstrate the efficacy of a minimally invasive, nonoperative, catheter-based approach to the treatment of traumatic chyle leak.
OBJECTIVE
To demonstrate the efficacy of a minimally invasive, nonoperative, catheter-based approach to the treatment of traumatic chyle leak.
METHODS
A retrospective review of 109 patients was conducted to assess the efficacy of thoracic duct embolization or interruption for the treatment of high-output chyle leak caused by injury to the thoracic duct.
RESULTS
A total of 106 patients presented with chylothorax, 1 patient presented with chylopericardium, and 2 patients presented with cervical lymphocele. Twenty patients (18%) had previous failed thoracic duct ligation. In 108 of 109 patients, a lymphangiogram was successful. Catheterization of the thoracic duct was achieved in 73 patients (67%). In 71 of these 73 patients, embolization of the thoracic duct was performed. Endovascular coils or liquid embolic agent was used to occlude the thoracic duct. In 18 of 33 cases of unsuccessful catheterization, thoracic duct needle interruption was attempted below the diaphragm. Resolution of the chyle leak was observed in 64 of 71 patients (90%) post-embolization. Needle interruption of the thoracic duct was successful in 13 of 18 patients (72%). In 17 of the 20 patients who had previous attempts at thoracic duct ligation, embolization or interruption was attempted and successful in 15 (88%). The overall success rate for the entire series was 71% (77/109). There were 3 (3%) minor complications.
CONCLUSION
Catheter embolization or needle interruption of the thoracic duct is safe, feasible, and successful in eliminating a high-output chyle leak in the majority (71%) of patients. This minimally invasive, although technically challenging, procedure should be the initial approach for the treatment of a traumatic chylothorax.
Topics: Chylothorax; Embolization, Therapeutic; Female; Humans; Male; Middle Aged; Pericardial Effusion; Retrospective Studies; Thoracic Duct
PubMed: 20042200
DOI: 10.1016/j.jtcvs.2009.11.025 -
Lymphatic Research and Biology Mar 2013Abstract An overview is presented of recent findings related to biology of aging of the lymph transport system. The authors discuss recently obtained data on the... (Review)
Review
Abstract An overview is presented of recent findings related to biology of aging of the lymph transport system. The authors discuss recently obtained data on the aging-associated alterations of lymphatic contractility in thoracic duct and mesenteric lymphatic vessels; on comparisons of function of aged mesenteric lymphatic vessels in situ versus isolated specimens and important conclusions which arose from these studies; on aging-associated changes in functional status of mast cells located close to aged mesenteric lymphatic vessels; on evidence of presence of oxidative stress in aged lymphatic vessels and changes in arrangement of muscle cells in their walls. The authors conclude that future continuation of the research efforts in this area is necessary and will be able to provide not only novel fundamental knowledge on the biology of lymphatic aging, but also will create solid foundation for the subsequent developments of lymphatic-oriented therapeutic interventions in many diseases of the elderly.
Topics: Age Factors; Aging; Animals; Humans; Lymphatic System; Mast Cells; Mesentery; Muscle Contraction; Muscle, Smooth; Thoracic Duct
PubMed: 23531179
DOI: 10.1089/lrb.2013.0003 -
American Journal of Physiology. Heart... Sep 2010The current study characterizes the mechanical properties of the human thoracic duct and demonstrates a role for adrenoceptors, thromboxane, and endothelin receptors in...
The current study characterizes the mechanical properties of the human thoracic duct and demonstrates a role for adrenoceptors, thromboxane, and endothelin receptors in human lymph vessel function. With ethical permission and informed consent, portions of the thoracic duct (2-5 cm) were resected and retrieved at T(7)-T(9) during esophageal and cardia cancer surgery. Ring segments (2 mm long) were mounted in a myograph for isometric tension (N/m) measurement. The diameter-tension relationship was established using ducts from 10 individuals. Peak active tension of 6.24 +/- 0.75 N/m was observed with a corresponding passive tension of 3.11 +/- 0.67 N/m and average internal diameter of 2.21 mm. The equivalent active and passive transmural pressures by LaPlace's law were 47.3 +/- 4.7 and 20.6 +/- 3.2 mmHg, respectively. Subsequently, pharmacology was performed on rings from 15 ducts that were normalized by stretching them until an equivalent pressure of 21 mmHg was calculable from the wall tension. At low concentrations, norepinephrine, endothelin-1, and the thromboxane-A(2) analog U-46619 evoked phasic contractions (analogous to lymphatic pumping), whereas at higher contractions they induced tonic activity (maximum tension values of 4.46 +/- 0.63, 5.90 +/- 1.4, and 6.78 +/- 1.4 N/m, respectively). Spontaneous activity was observed in 44% of ducts while 51% of all the segments produced phasic contractions after agonist application. Acetylcholine and bradykinin relaxed norepinephrine preconstrictions by approximately 20% and approximately 40%, respectively. These results demonstrate that the human thoracic duct can develop wall tensions that permit contractility to be maintained across a wide range of transmural pressures and that isolated ducts contract in response to important vasoactive agents.
Topics: 15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5,13-dienoic Acid; Acetylcholine; Adrenergic alpha-Agonists; Endothelin-1; Humans; Isometric Contraction; Myography; Norepinephrine; Receptors, Adrenergic; Thoracic Duct; Vasoconstrictor Agents; Vasodilator Agents
PubMed: 20511415
DOI: 10.1152/ajpheart.01089.2009 -
Medicine May 2020This study aimed to investigate the association between the degree of thoracic duct dilatation and the progression of chronic liver disease.In this cross-sectional and... (Observational Study)
Observational Study
This study aimed to investigate the association between the degree of thoracic duct dilatation and the progression of chronic liver disease.In this cross-sectional and retrospective study, 179 patients (mean age, 60.9 years; 114 men) with chronic liver disease who underwent chest CT were enrolled. Dilatation of the left distal thoracic ducts (DTD) was measured and divided into the following 3 grades according to the maximum transverse diameter: grade 0, invisible thoracic duct; grade 1, visible duct with <5-mm diameter; grade 2, diameter of ≥5 mm. Statistical analyses were conducted using the binary logistic regression model.The proportion of grade 2 DTD was notably higher as the chronic liver disease progressed to cirrhosis. Visible DTD on chest CT was significantly related to the presence of cirrhosis (odds ratio [OR], 3.809; P = .027) and significant varix (OR, 3.211; P = .025). Grade 2 DTD was observed more frequently in patients with ascites (OR, 2.788; P = .039). However, 40% of patients with cirrhosis and ascites still exhibited no visible DTD while demonstrating significant amount of ascites, and their ascites were more predominant of recent onset and transient than that observed in other patients (85.7% vs 48.4%, P = .010 and 66.7% vs 29.0%, P = .009, respectively).The degree of thoracic duct dilatation is significantly associated with progression to cirrhosis and advancement of portal hypertension. Further, insufficient lymph drainage to DTD might contribute to the development of ascites.
Topics: Aged; Ascites; Chronic Disease; Dilatation, Pathologic; Disease Progression; Female; Humans; Liver Cirrhosis; Male; Middle Aged; Retrospective Studies; Thoracic Duct
PubMed: 32481363
DOI: 10.1097/MD.0000000000019889 -
Thoracic Cancer May 2021The aim of this study was to investigate the impact of thoracic duct embolization (TDE) on the management of postoperative chyle leakage.
BACKGROUND
The aim of this study was to investigate the impact of thoracic duct embolization (TDE) on the management of postoperative chyle leakage.
METHODS
We retrospectively reviewed the electronic medical record database of 4171 patients who underwent curative resection for lung or esophageal cancer between January 2015 and June 2017. We classified the period before the introduction of TDE as the first period and the period after the introduction of TDE as the second period.
RESULTS
A total of 105 patients who developed chyle leakage after surgery were included. In the first period, 49 patients who underwent lung surgery developed chylothorax. Of those, two patients (4.1%) underwent surgical ligation of the thoracic duct (TD). Of eight patients with chyle leakage after esophagectomy, four patients (50%) underwent TD ligation. In the second period, 30 patients developed postoperative chyle leakage after pulmonary resection. Only one (3.3%) of them required surgical ligation. Of eight patients with chyle leakage after esophagectomy, only two (11.1%) patients underwent TD ligation. Five patients (16.7%) received TDE after lung surgery and five patients (27.7%) after esophageal surgery. Also, in the second period, the hospital stay of patients who underwent lung cancer surgery was shorter than the first period (12.6 ± 4.6 days vs. 16.3 ± 9.7 days; p = 0.026).
CONCLUSIONS
TDE is an effective method for the management of chyle leakage and might help to avoid invasive surgery.
Topics: Adult; Aged; Aged, 80 and over; Chyle; Embolization, Therapeutic; Female; Humans; Male; Middle Aged; Retrospective Studies; Thoracic Duct; Thoracic Surgical Procedures
PubMed: 33783956
DOI: 10.1111/1759-7714.13914 -
Thorax Mar 1970
Topics: Contrast Media; Humans; Lymphatic System; Lymphography; Pulmonary Embolism; Thoracic Duct
PubMed: 5442002
DOI: 10.1136/thx.25.2.256 -
Medical Science Monitor : International... Apr 2020BACKGROUND This study was carried out to evaluate the effects of a long-term high-fat diet on lipids and lipoproteins composition in thoracic duct lymph in pigs....
BACKGROUND This study was carried out to evaluate the effects of a long-term high-fat diet on lipids and lipoproteins composition in thoracic duct lymph in pigs. MATERIAL AND METHODS We examined lymph taken from the thoracic duct from 24 female white sharp-ear pigs, divided into 3 experimental groups fed different diets for 12 months: (a) the control group, fed the standard balanced diet; (b) the HFD group, fed an unbalanced, high-fat diet, and (c) the reversal diet group (RD), fed an unbalanced, high-fat diet for 9 months and then a standard balanced diet for 3 months. RESULTS Lymph analysis after 12 months of fixed diets revealed significantly higher concentration of proteins in the HFD group in comparison to the control and RD groups. Examination of lymph lipoproteins fractions showed that the high-fat diet in the HFD group in comparison to control group caused an increase in cholesterol, phospholipids, and proteins content within HDL and chylomicrons. There were also more proteins within HDL in the HFD group in comparison to the RD group and more triglycerides within chylomicrons in the HFD group in comparison to the control group. CONCLUSIONS A long-term high-fat diet resulted in changed structure of HDL and chylomicrons in the thoracic duct lymph. Alterations in HDL composition suggest that a high-fat diet enhances reverses cholesterol transport. Changes in chylomicrons structure show the adaptation to more intense transport of dietary fat from the intestine to the liver under the influence of a high-fat diet. Reversal to a standard balanced diet had the opposite effects.
Topics: Animals; Cholesterol; Diet, High-Fat; Dietary Fats; Female; Lipid Metabolism; Lipids; Lipoproteins; Lipoproteins, HDL; Lipoproteins, LDL; Liver; Lymph; Swine; Thoracic Duct; Triglycerides
PubMed: 32302294
DOI: 10.12659/MSM.917221