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Davies et al: Lymphaticovenous anastomosis of the caudal thoracic duct to the azygous vein: A feline cadaver study
Veterinary Surgery 7, 2024

🔍 Key Findings

  • Lymphaticovenous anastomosis (TD to AV) was successfully performed in all 8 feline cadavers using a microvascular anastomotic coupler (MAC).
  • Anastomotic patency was confirmed intraoperatively and postoperatively in 7/8 cats via contrast lymphography or retrograde venography.
  • Dissection and anastomosis took a median of 120 minutes, with minimal technical complications.
  • A 1.5 mm MAC was used in 6 cats, and a 2.0 mm in 2 cats; TD diameter ranged 1.0–1.5 mm, AV up to 2.25 mm.
  • Challenges included vessel twisting and luminal patency issues, resolved intraoperatively with minor adjustments (e.g., repeat pinning, tacking suture).
  • MAC use eliminated need for hand-suturing, lowering skill demands but requiring precise alignment.
  • Technique provides direct lymphatic-to-venous drainage, potentially reducing the stimulus for collateral vessel formation.
  • May serve as a future treatment option for feline idiopathic chylothorax, warranting further in vivo studies.

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← Articles

Davies et al: Lymphaticovenous anastomosis of the caudal thoracic duct to the azygous vein: A feline cadaver study
Veterinary Surgery 7, 2024

🔍 Key Findings

  • Lymphaticovenous anastomosis (TD to AV) was successfully performed in all 8 feline cadavers using a microvascular anastomotic coupler (MAC).
  • Anastomotic patency was confirmed intraoperatively and postoperatively in 7/8 cats via contrast lymphography or retrograde venography.
  • Dissection and anastomosis took a median of 120 minutes, with minimal technical complications.
  • A 1.5 mm MAC was used in 6 cats, and a 2.0 mm in 2 cats; TD diameter ranged 1.0–1.5 mm, AV up to 2.25 mm.
  • Challenges included vessel twisting and luminal patency issues, resolved intraoperatively with minor adjustments (e.g., repeat pinning, tacking suture).
  • MAC use eliminated need for hand-suturing, lowering skill demands but requiring precise alignment.
  • Technique provides direct lymphatic-to-venous drainage, potentially reducing the stimulus for collateral vessel formation.
  • May serve as a future treatment option for feline idiopathic chylothorax, warranting further in vivo studies.

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Multiple Choice Questions on this study

In Davies 2024 et al., on lymphaticovenous anastomosis, what was used to create the end-to-end connection?

A. Monofilament suture
B. Microsurgical hand-sewn technique
C. Surgical stapler
D. Microvascular anastomotic coupler (MAC)
E. Biologic adhesive

Answer: Microvascular anastomotic coupler (MAC)

Explanation: A commercially available MAC device enabled end-to-end coupling of TD to AV.
In Davies 2024 et al., on lymphaticovenous anastomosis, what intervention resolved partial occlusion of the thoracic duct after MAC coupling in one cat?

A. Flushing with heparin
B. Tacking suture between TD and thoracic wall
C. Use of a larger MAC
D. Inversion of the coupler ring
E. Bypass with a second anastomosis

Answer: Tacking suture between TD and thoracic wall

Explanation: Twisting of the TD was corrected by anchoring it with a tacking suture.
In Davies 2024 et al., on lymphaticovenous anastomosis, what is the proposed advantage of creating a TD to AV anastomosis over traditional TD ligation and cisterna chyli ablation?

A. Improved thoracic visualization
B. Lower intraoperative hemorrhage
C. Reduced need for imaging
D. Direct lymphatic drainage to central veins
E. Enhanced immune cell circulation

Answer: Direct lymphatic drainage to central veins

Explanation: TD to AV connection reduces stimulus for collateral formation and may prevent leakage.
In Davies 2024 et al., on lymphaticovenous anastomosis, which technique confirmed postoperative anastomotic patency in most cadavers?

A. Thoracoscopy
B. Cisterna chyli injection with dye
C. Ultrasound guidance
D. CT angiography
E. Mesenteric contrast lymphography

Answer: Mesenteric contrast lymphography

Explanation: Contrast injected into mesenteric lymph nodes confirmed flow through the TD-MAC-AV pathway.
In Davies 2024 et al., on lymphaticovenous anastomosis, what was the main technical issue encountered during pinning to the MAC?

A. Excessive bleeding from the AV
B. Retrograde flow of venous blood
C. Tearing of the thoracic duct
D. Lack of contrast in imaging
E. Luminal patency difficulty during vessel pinning

Answer: Luminal patency difficulty during vessel pinning

Explanation: Poor luminal visibility required repeat pinning in one cat to ensure flow through the TD.

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