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Welker et al: Anastomosis of the caudal thoracic duct and intercostal vein using a microvascular anastomotic coupler device: Experimental study in six dogs
Veterinary Surgery 7, 2024

🔍 Key Findings

  • Anastomosis of the thoracic duct (TD) to the intercostal vein (ICV) using a microvascular anastomotic coupler (MAC) was feasible in all 6 healthy dogs
  • Immediate postoperative patency was confirmed in all dogs, but only 4/6 had patent anastomoses at 30 days, with 2 failing due to ICV kinking
  • Kinking of the ICV near the azygos vein insertion was the primary failure mechanism, likely from MAC malalignment
  • No intraoperative or major postoperative complications occurred, though 2 dogs developed mild seromas
  • Use of the MAC device simplified microsurgical anastomosis versus hand suturing, especially in the deep thoracic cavity
  • Contrast lymphangiography showed faster clearance from the cisterna chyli postoperatively, suggesting effective flow redirection
  • Persistent branches of the thoracic duct may impact outcomes, and should be ligated during surgery
  • This technique may be a potential novel treatment for idiopathic chylothorax, improving outcomes by reducing collateral flow stimuli

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← Articles

Welker et al: Anastomosis of the caudal thoracic duct and intercostal vein using a microvascular anastomotic coupler device: Experimental study in six dogs
Veterinary Surgery 7, 2024

🔍 Key Findings

  • Anastomosis of the thoracic duct (TD) to the intercostal vein (ICV) using a microvascular anastomotic coupler (MAC) was feasible in all 6 healthy dogs
  • Immediate postoperative patency was confirmed in all dogs, but only 4/6 had patent anastomoses at 30 days, with 2 failing due to ICV kinking
  • Kinking of the ICV near the azygos vein insertion was the primary failure mechanism, likely from MAC malalignment
  • No intraoperative or major postoperative complications occurred, though 2 dogs developed mild seromas
  • Use of the MAC device simplified microsurgical anastomosis versus hand suturing, especially in the deep thoracic cavity
  • Contrast lymphangiography showed faster clearance from the cisterna chyli postoperatively, suggesting effective flow redirection
  • Persistent branches of the thoracic duct may impact outcomes, and should be ligated during surgery
  • This technique may be a potential novel treatment for idiopathic chylothorax, improving outcomes by reducing collateral flow stimuli

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Multiple Choice Questions on this study

In Welker 2024 et al., on thoracic duct anastomosis with MAC device, which imaging technique confirmed postoperative flow?

A. CT angiography
B. MR lymphangiography
C. Fluoroscopy alone
D. Contrast lymphangiography
E. Thoracoscopy

Answer: Contrast lymphangiography

Explanation: This method was used to demonstrate flow and clearance from the cisterna chyli.
In Welker 2024 et al., on thoracic duct anastomosis with MAC device, what percentage of dogs had patent anastomoses at 30 days?

A. 100%
B. 83%
C. 67%
D. 50%
E. 33%

Answer: 67%

Explanation: Four out of six dogs had patent anastomoses confirmed at 30 days.
In Welker 2024 et al., on thoracic duct anastomosis with MAC device, what complication was noted in two dogs postoperatively?

A. Pleural effusion
B. Sepsis
C. Device migration
D. Seroma formation
E. Respiratory distress

Answer: Seroma formation

Explanation: Seromas were mild and resolved without major intervention.
In Welker 2024 et al., on thoracic duct anastomosis with MAC device, what surgical consideration is recommended to improve outcomes?

A. Ligation of persistent thoracic duct branches
B. Use of absorbable sutures in ICV
C. Permanent drainage of thoracic cavity
D. Post-op pleurodesis
E. Resection of azygos vein

Answer: Ligation of persistent thoracic duct branches

Explanation: Persistent branches were suspected to impair redirection of flow and may require ligation during surgery.

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