Anatomical variations in distal portion of the thoracic duct—A systematic review

Abstract

The objective of this study was to identify and analyze the anatomical variations in the termination of the thoracic duct (TD) in cadavers or patients by anatomical dissections and surgical or radiological procedures for better knowledge of the interindividual variations through a systematic review. The search strategy included PubMed and reference tracking. Studies were identified by searching the electronic Medline databases. The search terms included “TD,” “Jugular Vein,” “Subclavian Vein,” or “Cervical,” and the protocol used is reported herein. These search results yielded 20 qualitative review articles out of the 275 articles consulted. We collected all the important data from these 20 articles with 1,352 TD analyzed by varying sources in our search. Regarding the characteristics of the studies and the anatomy of the TD, the results were heterogeneous. The TD most commonly terminates in the internal jugular vein in 54.05% of cases (95% confidence interval [CI]: 54.03; 54.07), in the jugular‐venous angle in 25.79% (95% CI: 25.77; 25.81), and in the subclavian vein in 8.16% of cases (95% CI: 8.14;8.18). Other terminations were found in 12% of cases. This systematic review provided an overview of the variations in the distal portion of the TD. This study can be helpful for surgeons in selecting the most appropriate methods to achieve successful surgical results and avoid complications, such as chylothorax; it also offers detailed information on the cervical termination of the TD in new diagnostic and therapeutic methods involving the TD. Clin. Anat. 32:99–107, 2019. © 2019 Wiley Periodicals, Inc.

The Critical Appraisal Tool for Anatomical Meta‐analysis: A framework for critically appraising anatomical meta‐analyses

“…In this article, we introduced the CATAM rubric and used it to critically appraise a recently published anatomical MA (Kacprzyk et al, 2020). There have been other anatomical MAs recently published (Aldabe et al, 2019; Bellier et al, 2020; Berthaume & Bull, 2021; Cheruiyot et al, 2021; Dreher et al, 2018; Graves et al, 2017; Harvie et al, 2019; Koziej et al, 2020; Morelli et al, 2019; Nallikuzhy et al, 2018; Roberts et al, 2021; Sirico et al, 2019; Solewski et al, 2021; Stefura et al, 2018; Tomaszewska et al, 2018; Tomaszewska et al, 2018; Tomaszewski et al, 2017; Tomaszewski et al, 2017; Vikse et al, 2016a, 2016b; Whitley et al, 2020; Yammine, 2013, 2014b, 2014c, 2014d; Yammine et al, 2015; Yurasakpong et al, 2021). We believe that the running paper that we used is an exemplary anatomical MA (Kacprzyk et al, 2020).…”

An effective method to reduce lymphatic drainage post-lateral cervical lymph node dissection of differentiated thyroid cancer: a retrospective analysis

“…The remaining 1/4 of the systemic lymph is drained into the right subclavian vein via the lymphatic duct [ 15 – 17 ]. They have different degrees of individual anatomic variation in this region [ 18 ]. The anatomic variation and transparent appearance of the lymphatic duct increase the risk of iatrogenic injury during surgery.…”

Postmortem Retrograde Contrasted Infusion in Thoracic Duct Outflow: Imaging Effectiveness Analysis

“…Another relevant aspect of this study is that drainage of the thoracic duct was not detected directly in the left internal jugular vein or in the left subclavian vein, which confirms the predominance of lymphatic confluence in the jugular-subclavian region in up to 73.3% of the cases [ 1 ]. On the other hand, the TD can lead to the left internal jugular vein in 36.2% [ 25 ] to 55.5% of cases [ 26 ], or even in the left subclavian vein from 17% [ 27 ] to 22.3% of the cases [ 26 , 28 ]. Even though TD is the largest lymphatic vessel in the human body with a luminal diameter of up to 5 mm [ 3 ], there was no contrast progression within it due to valvular resistance near its outflow into the left venous angle.…”