Preparation of chronic thoracic duct lymph fistulas in man and laboratory animals

Abstract

Thoracic duct lymph fistulas were maintained from 20 to 150 days in 13 patients. The indications for long-term lymph fistulas were lymph dialysis for chronic renal failure in 11 patients and lymph decompression for ascites in 2. The important technical features are the use of a Teflon tip in the thoracic duct and Silastic tubing for both the lymphatic drainage cannula and venous reinfusion cannula. Both cannulas exit through a Silastic skin exit device implanted in the chest wall, which has largely prevented the complication of accidental removal. The average lymph flow per patient ranged between 3.2 and 9.8 liters per 1.73 sq. m. per day, and the total lymph drained varied between 130 and 1,125 liters. Short-term lymph fistulas were prepared in 7 other patients for study purposes. With the same equipment, 9 calves were studied with lymph fistulas remaining open from 5 to 23 days. Lymph fistulas prepared by this method eventually failed because of lymph clotting in the cannula tip. Clotting was enhanced by hematochylia and decreased lymph flow rates. Successful long-term fistulas can be prepared in man and laboratory animals. Studies of lymphocyte dynamics, cellular immunity, and other physiological phenomena are greatly facilitated by the ability to maintain long-term lymph fistulas.