Microsurgical Thoracic Duct Lymphovenous Bypass in the Adult Population

Summary:. Thoracic duct occlusion can lead to devastating complications, resulting in recalcitrant chylothoraces, ascites, generalized lymphedema, metabolic derangement, and death. Lymphatic extravasation has traditionally been managed conservatively and, in recent years, using minimally invasive te...

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Autores principales:	Sammy Othman, MD, Saïd C. Azoury, MD, Kevin Klifto, DO, PharmD, Yoshiko Toyoda, MD, Maxim Itkin, MD, FSIR, Stephen J. Kovach, MD
Formato:	article
Lenguaje:	EN
Publicado:	Wolters Kluwer 2021
Materias:	Surgery RD1-811
Acceso en línea:	https://doaj.org/article/187fadbc94a1414ba79aeda300a31dbd
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spelling	oai:doaj.org-article:187fadbc94a1414ba79aeda300a31dbd2021-11-25T07:57:34ZMicrosurgical Thoracic Duct Lymphovenous Bypass in the Adult Population2169-757410.1097/GOX.0000000000003875https://doaj.org/article/187fadbc94a1414ba79aeda300a31dbd2021-10-01T00:00:00Zhttp://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003875https://doaj.org/toc/2169-7574Summary:. Thoracic duct occlusion can lead to devastating complications, resulting in recalcitrant chylothoraces, ascites, generalized lymphedema, metabolic derangement, and death. Lymphatic extravasation has traditionally been managed conservatively and, in recent years, using minimally invasive techniques, such as thoracic duct ligation and embolization. However, these measures are often limited in application and therapeutic success, resulting in chronically difficult conditions with few modalities available for definitive management. Advances in microsurgery have allowed for surgical treatment and resolution of peripherally-based lymphatic pathology, though microsurgical intervention to address central lymphatic abnormalities is scarcely described. This report is the first series detailing experiences utilizing microsurgical thoracic duct lymphovenous bypass in a refractory adult population with thoracic duct occlusion. Four patients successfully underwent the procedure, with three achieving complete resolution of symptoms. The fourth patient enjoyed partial resolution, though ubiquitous lymphatic deformities have conferred recurrent residual lower-extremity peripheral edema requiring future intervention. Postoperatively, patent anastomoses were confirmed under magnetic resonance lymphangiography. This series demonstrates the feasibility of microsurgical thoracic duct lymphovenous bypass as a promising technique in treating patients suffering from thoracic duct occlusion. This intervention is effective for recalcitrant chylothorax, chylous ascites, and generalized lymphedema, particularly when traditional and interventional radiological techniques are unsuccessful.Sammy Othman, MDSaïd C. Azoury, MDKevin Klifto, DO, PharmDYoshiko Toyoda, MDMaxim Itkin, MD, FSIRStephen J. Kovach, MDWolters KluwerarticleSurgeryRD1-811ENPlastic and Reconstructive Surgery, Global Open, Vol 9, Iss 10, p e3875 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Surgery RD1-811
spellingShingle	Surgery RD1-811 Sammy Othman, MD Saïd C. Azoury, MD Kevin Klifto, DO, PharmD Yoshiko Toyoda, MD Maxim Itkin, MD, FSIR Stephen J. Kovach, MD Microsurgical Thoracic Duct Lymphovenous Bypass in the Adult Population
description	Summary:. Thoracic duct occlusion can lead to devastating complications, resulting in recalcitrant chylothoraces, ascites, generalized lymphedema, metabolic derangement, and death. Lymphatic extravasation has traditionally been managed conservatively and, in recent years, using minimally invasive techniques, such as thoracic duct ligation and embolization. However, these measures are often limited in application and therapeutic success, resulting in chronically difficult conditions with few modalities available for definitive management. Advances in microsurgery have allowed for surgical treatment and resolution of peripherally-based lymphatic pathology, though microsurgical intervention to address central lymphatic abnormalities is scarcely described. This report is the first series detailing experiences utilizing microsurgical thoracic duct lymphovenous bypass in a refractory adult population with thoracic duct occlusion. Four patients successfully underwent the procedure, with three achieving complete resolution of symptoms. The fourth patient enjoyed partial resolution, though ubiquitous lymphatic deformities have conferred recurrent residual lower-extremity peripheral edema requiring future intervention. Postoperatively, patent anastomoses were confirmed under magnetic resonance lymphangiography. This series demonstrates the feasibility of microsurgical thoracic duct lymphovenous bypass as a promising technique in treating patients suffering from thoracic duct occlusion. This intervention is effective for recalcitrant chylothorax, chylous ascites, and generalized lymphedema, particularly when traditional and interventional radiological techniques are unsuccessful.
format	article
author	Sammy Othman, MD Saïd C. Azoury, MD Kevin Klifto, DO, PharmD Yoshiko Toyoda, MD Maxim Itkin, MD, FSIR Stephen J. Kovach, MD
author_facet	Sammy Othman, MD Saïd C. Azoury, MD Kevin Klifto, DO, PharmD Yoshiko Toyoda, MD Maxim Itkin, MD, FSIR Stephen J. Kovach, MD
author_sort	Sammy Othman, MD
title	Microsurgical Thoracic Duct Lymphovenous Bypass in the Adult Population
title_short	Microsurgical Thoracic Duct Lymphovenous Bypass in the Adult Population
title_full	Microsurgical Thoracic Duct Lymphovenous Bypass in the Adult Population
title_fullStr	Microsurgical Thoracic Duct Lymphovenous Bypass in the Adult Population
title_full_unstemmed	Microsurgical Thoracic Duct Lymphovenous Bypass in the Adult Population
title_sort	microsurgical thoracic duct lymphovenous bypass in the adult population
publisher	Wolters Kluwer
publishDate	2021
url	https://doaj.org/article/187fadbc94a1414ba79aeda300a31dbd
work_keys_str_mv	AT sammyothmanmd microsurgicalthoracicductlymphovenousbypassintheadultpopulation AT saidcazourymd microsurgicalthoracicductlymphovenousbypassintheadultpopulation AT kevinkliftodopharmd microsurgicalthoracicductlymphovenousbypassintheadultpopulation AT yoshikotoyodamd microsurgicalthoracicductlymphovenousbypassintheadultpopulation AT maximitkinmdfsir microsurgicalthoracicductlymphovenousbypassintheadultpopulation AT stephenjkovachmd microsurgicalthoracicductlymphovenousbypassintheadultpopulation
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Microsurgical Thoracic Duct Lymphovenous Bypass in the Adult Population

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