{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,29]],"date-time":"2025-11-29T00:43:55Z","timestamp":1764377035424,"version":"3.40.5"},"reference-count":42,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,12,11]],"date-time":"2023-12-11T00:00:00Z","timestamp":1702252800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Veterinary Surgery"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate a left\u2010sided fourth intercostal approach to thoracic duct (TD) ligation and unilateral subphrenic pericardiectomy in dogs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study design<\/jats:title><jats:p>Retrospective computed tomography (CT) review and cadaveric study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Animals<\/jats:title><jats:p>Thirteen dogs with idiopathic chylothorax and 10 canine cadavers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective study of CT lymphangiograms in client\u2010owned dogs with idiopathic chylothorax evaluated location and branching of the TD at the left fourth intercostal space. A cadaveric study evaluated the efficacy of TD ligation at this site. Following methylene blue mesenteric lymph node injection, TDs were identified through a left fourth intercostal thoracotomy, ligated, and sealed. Unilateral subphrenic pericardiectomy was performed through the same incision. Computed tomography scans were performed to determine the success of TD ligation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A review of lymphangiograms revealed a single TD in 10\/13 clinical cases at the fourth intercostal space. Three cases had additional branches. Thoracic duct ligation via a left fourth intercostal thoracotomy was successful in nine out of 10 cadavers. A single branch was noted intraoperatively in six out of 10, and two branches were noted in four out of 10 cadavers. All branches were observed on the left side of the esophagus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>TD ligation at the left fourth intercostal space was successfully performed in 9\/10 canine cadavers and appeared feasible in a retrospective review of 10\/13 clinical cases. Unilateral subphrenic pericardiectomy can also be performed via this approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical significance<\/jats:title><jats:p>Fewer thoracic duct branches at this location in comparison with the standard caudal location may simplify TD ligation. If elected, unilateral subphrenic pericardiectomy can be performed through the same incision. Further investigation in clinical patients is warranted.<\/jats:p><\/jats:sec>","DOI":"10.1111\/vsu.14060","type":"journal-article","created":{"date-parts":[[2023,12,11]],"date-time":"2023-12-11T18:36:00Z","timestamp":1702319760000},"page":"437-446","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Evaluation of thoracic duct ligation and unilateral subphrenic pericardiectomy via a left fourth intercostal approach in normal canine cadavers"],"prefix":"10.1111","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2732-6126","authenticated-orcid":false,"given":"Anya K.","family":"Price","sequence":"first","affiliation":[{"name":"Departments of Clinical Sciences North Carolina State University College of Veterinary Medicine Raleigh North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3431-6049","authenticated-orcid":false,"given":"Kyle G.","family":"Mathews","sequence":"additional","affiliation":[{"name":"Departments of Clinical Sciences North Carolina State University College of Veterinary Medicine Raleigh North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4980-9199","authenticated-orcid":false,"given":"Jody E.","family":"Lawver","sequence":"additional","affiliation":[{"name":"Molecular and Biomedical Sciences Raleigh North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5011-9005","authenticated-orcid":false,"given":"Valery F.","family":"Scharf","sequence":"additional","affiliation":[{"name":"Departments of Clinical Sciences North Carolina State University College of Veterinary Medicine Raleigh North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,12,11]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1939-1676.2004.tb02550.x"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/vr.163.25.743"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/vsu.13322"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-950X.2011.00902.x"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1053\/jvet.2002.31062"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-950X.2009.00623.x"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/vsu.13113"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/vsu.13370"},{"key":"e_1_2_9_10_1","doi-asserted-by":"crossref","first-page":"696","DOI":"10.2460\/javma.22.08.0381","article-title":"Resolution, recurrence and chyle redistribution after thoracic duct ligation with or without pericardiectomy in dogs with naturally occurring idiopathic chylothorax","volume":"261","author":"Mayhew PD","year":"2023","journal-title":"J Am Vet Med Assoc"},{"key":"e_1_2_9_11_1","first-page":"948","article-title":"Variations in the canine thoracic duct system and the effects of surgical occlusion demonstrated by rapid aqueous lymphography, using an intestinal lymphatic trunk","volume":"40","author":"Kagan KG","year":"1979","journal-title":"Am J Vet Res"},{"key":"e_1_2_9_12_1","first-page":"769","article-title":"Lymphangiography and ligation of the canine thoracic duct: a study in normal dogs and three dogs with chylothorax","volume":"18","author":"Birchard SJ","year":"1982","journal-title":"J Am Anim Hosp Assoc"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1740-8261.2006.00165.x"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0195-5616(87)50027-4"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/vru.12966"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-950X.2008.00437.x"},{"key":"e_1_2_9_17_1","first-page":"278","article-title":"En bloc ligatie van de ductus thoracicus bij twaalf honden met idiopatische chylothorax [En bloc ligation of the thoracic duct in twelve dogs with idiopathic chylothorax]","volume":"128","author":"Viehoff FW","year":"2003","journal-title":"Tijdschr Diergeneeskd"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-950x.2005.00012.x"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-950X.2005.00078.x"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/vsu.13195"},{"key":"e_1_2_9_21_1","first-page":"622","volume-title":"Miller and Evans' Anatomy of the Dog","author":"Hermanson J","year":"2020"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.4314\/ovj.v10i1.11"},{"volume-title":"Der Ductus Thoracicus von Pferd, Rind, Hund und Schwein","year":"1909","author":"Huber F","key":"e_1_2_9_23_1"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-950X.2008.00473.x"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/ahe.12745"},{"key":"e_1_2_9_26_1","first-page":"68","article-title":"Results of thoracic duct ligation in dogs with chylothorax","volume":"193","author":"Birchard SJ","year":"1988","journal-title":"J Am Vet Med Assoc"},{"key":"e_1_2_9_27_1","first-page":"967","article-title":"Lymphangiographic evaluation of experimentally induced chylothorax after ligation of the cranial vena cava in dogs","volume":"47","author":"Fossum TW","year":"1986","journal-title":"Am J Vet Res"},{"key":"e_1_2_9_28_1","first-page":"64","article-title":"Chylothorax in the dog and cat: a review","volume":"28","author":"Birchard SJ","year":"1995","journal-title":"Lymphology"},{"key":"e_1_2_9_29_1","first-page":"E1","article-title":"Idiopathic chylothorax: pathophysiology, diagnosis, and thoracic duct imaging","volume":"34","author":"Singh A","year":"2012","journal-title":"Compend Contin Educ Vet"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.4314\/ovj.v6i3.13"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/vsu.12740"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cvsm.2019.10.008"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/vru.12865"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1292\/jvms.22-0043"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1053\/jvet.2003.50044"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-950X.2011.00860.x"},{"key":"e_1_2_9_37_1","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.2460\/javma.1995.206.10.1561","article-title":"Chylothorax associated with constrictive pericarditis in a dog","volume":"206","author":"Campbell SL","year":"1995","journal-title":"J Am Vet Med Assoc"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2005.08.009"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.5830\/CVJA-2013-042"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/vsu.12739"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1939-1676.1999.tb02205.x"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.3390\/ani11051438"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1111\/jsap.12138"}],"container-title":["Veterinary Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/vsu.14060","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T19:37:20Z","timestamp":1730835440000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/vsu.14060"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,11]]},"references-count":42,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,4]]}},"alternative-id":["10.1111\/vsu.14060"],"URL":"https:\/\/doi.org\/10.1111\/vsu.14060","archive":["Portico"],"relation":{},"ISSN":["0161-3499","1532-950X"],"issn-type":[{"type":"print","value":"0161-3499"},{"type":"electronic","value":"1532-950X"}],"subject":[],"published":{"date-parts":[[2023,12,11]]},"assertion":[{"value":"2023-06-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-11-24","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-12-11","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}